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Sirisena M, Birman CS, McKibbin AJ, O'Brien KJ. Bilateral auditory ossicular expansions in a child with beta-thalassemia major: Case report and literature review. Int J Pediatr Otorhinolaryngol 2018; 112:126-131. [PMID: 30055721 DOI: 10.1016/j.ijporl.2018.06.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 12/12/2022]
Abstract
Marrow proliferation of the ossicular chain is a rare phenomenon. To date, only two other cases have described this rarity. We report a third paediatric case from Australia. A seven-year-old with thalassemia major demonstrated conductive impairment during surveillance for Deferasirox ototoxicity. Otitis media was assumed, however, CT scan of the petrous temporal bone revealed extramedullary haematopoiesis causing bilateral ossicular expansions and fixed conductive deficit. Reports of hearing loss in the thalassemia population focus on sensorineural impairment from iron chelation therapies. Clinicians should suspect ossicular deformation where treatment has been delayed, poorly controlled or conductive deficit persists without effusion.
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Affiliation(s)
- Melisha Sirisena
- Department of Audiology, The Sydney Children's Hospital Network (Westmead), Level 2, Locked Bag 4001, Westmead, NSW, 2145, Australia.
| | - Catherine S Birman
- Department of Otolaryngology (ENT), The Sydney Children's Hospital Network (Westmead), Sydney Medical School, The University of Sydney, The Sydney Cochlear Implant Centre, PO Box 188, Gladesville, NSW, 1675, Australia.
| | - Amy J McKibbin
- Department of Audiology, The Sydney Children's Hospital Network (Westmead), Level 2, Locked Bag 4001, Westmead, NSW, 2145, Australia.
| | - Katie J O'Brien
- Department of Audiology, The Sydney Children's Hospital Network (Westmead), Level 2, Locked Bag 4001, Westmead, NSW, 2145, Australia.
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Chen LN, Espinel A, Reilly B, Luca DC. Extramedullary Hematopoiesis Presenting as Bilateral Glomus Tympanicum-First Case Report in a Pediatric Patient and With Bilateral Presentation. Pediatr Dev Pathol 2018; 21:332-334. [PMID: 28488469 DOI: 10.1177/1093526617704267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To the best of our knowledge, this is the first case report of middle ear extramedullary hematopoiesis (EMH) in a pediatric patient as well as the first bilateral presentation reported in both children and adults. We report a 13-year-old African-American female with sickle cell disease who developed bilateral hearing loss, with magnetic resonance imaging findings consistent with bilateral glomus tympanicum (GT). Upon excisional biopsy, however, EMH was diagnosed histologically. Besides its novelty, this case highlights the importance of considering EMH in the differential diagnosis of GT including cases with bilateral presentation that may be otherwise highly suggestive of the familial form of GT.
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Affiliation(s)
- Leonard N Chen
- 1 Department of Pathology, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Alexandra Espinel
- 2 Department of Otolaryngology, Children's National Medical Center, Washington, District of Columbia
| | - Brian Reilly
- 2 Department of Otolaryngology, Children's National Medical Center, Washington, District of Columbia
| | - Dragos C Luca
- 3 Department of Pathology, Children's National Medical Center, Washington, District of Columbia
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3
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Lanigan A, Fordham MT. Temporal bone extramedullary hematopoiesis as a causeof pediatric bilateral conductive hearing loss:Case report and review of the literature. Int J Pediatr Otorhinolaryngol 2017; 97:135-138. [PMID: 28483223 DOI: 10.1016/j.ijporl.2017.03.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/23/2017] [Accepted: 03/26/2017] [Indexed: 11/29/2022]
Abstract
Extramedullary hematopoiesis occurs in children with hemoglobinopathy and chronic anemia. The liver and spleen are often affected first, but other foci can develop to support erythrocyte demand. We report a case of a nine-year-old with beta thalassemia and temporal bone extramedullary hematopoiesis causing ossicular fixation and bilateral conductive hearing loss. There is only one case in the literature describing this phenomenon in pediatric patients, and this is the first case report of bilateral hearing loss from this physiologic phenomenon. Otolaryngologists should consider this etiology in patients with chronic anemia and conductive hearing loss in the absence of otitis media.
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Affiliation(s)
- Alexander Lanigan
- Dept. Otolaryngology-Head & Neck Surgery, San Antonio Military Medical Center, San Antonio, TX, USA.
| | - M Taylor Fordham
- Dept. of Pediatric Otolaryngology, Children's Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, USA
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Mattei TA, Higgins M, Joseph F, Mendel E. Ectopic extramedullary hematopoiesis: evaluation and treatment of a rare and benign paraspinal/epidural tumor. J Neurosurg Spine 2013; 18:236-42. [DOI: 10.3171/2012.12.spine12720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ectopic extramedullary hematopoiesis (EMH), defined as the formation of blood cells outside the bone marrow, usually occurs in a scenario of chronic anemia when, even after conversion of the bony yellow marrow to red marrow, the body is still unable to meet the demand for red blood cells. Ectopic extramedullary hematopoiesis most commonly occurs in the liver and spleen but may, in fact, occur almost anywhere in the body. Although previous reports have documented EMH presenting as paraspinal masses, such lesions have almost always been associated with a predisposing hematological disorder such as hemolytic anemia, myelofibrosis or myelodysplastic syndromes, thalassemia, polycythemia vera, leukemia, or lymphoma.
The authors of this report describe the first reported instance of EMH in a patient presenting with a symptomatic epidural and paraspinal cervical lesion arising from the posterior spinal elements and no known predisposing hematological disease. Initial radiographs revealed a bony lesion arising posteriorly from the C2–3 laminae and spinous processes. Subsequent imaging suggested the diagnosis, which was confirmed by CT-guided biopsy, peripheral blood smears, and bone marrow aspirate. Despite epidural compression and slight displacement of the cervical cord and thecal sac, the patient's symptoms were limited to pain and diminished cervical range of motion. Therefore, surgery was deferred in favor of nonsurgical therapy. Several alternative modalities for the treatment of EMH have been suggested in the literature, including cytotoxic agents and radiotherapy. The authors opted for an approach utilizing directed low-dose radiotherapy of a total of 25 Gy divided in 2.5-Gy fractions. At the 3-month follow-up, the patient continued to be asymptomatic, and MRI demonstrated a significant reduction in the dimensions of the lesion.
Extramedullary hematopoiesis with spinal cord compression in the absence of a preexisting hematological disorder has not been described in the context of clinical neurosurgical practice. Recognizing that EMH may present as an epidural or paraspinal lesion is important since chemotherapy and radiotherapy are effective therapeutic options in the majority of patients who suffer few if any symptoms. Extensive evaluation for underlying hematological disorders is necessary before undertaking directed therapy. Inadvertent resection of these highly vascularized masses may risk catastrophic intraoperative hemorrhage with no proven benefit as compared with medical treatment, which usually provides excellent long-term outcomes.
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Affiliation(s)
- Tobias A. Mattei
- 1Department of Neurosurgery, University of Illinois at Peoria, Illinois; and
| | | | - Flynn Joseph
- 3Division of Hematology, The Ohio State University James Cancer Hospital and Wexner Medical Center, Columbus, Ohio
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Moghe S, Pillai A, Guru KN, Nair PP. Idiopathic facial swelling secondary to sickle cell anaemia. BMJ Case Rep 2012; 2012:bcr-2012-007132. [PMID: 23060382 DOI: 10.1136/bcr-2012-007132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sickle cell disease is a common inherited autosomal disease that is characterised by abnormally shaped (sickle-shaped) red blood cells (RBCs). It can involve virtually any organ system. The clinical manifestations of sickle cell disease vary and are classified as vaso-occlusion, chronic anaemia and infection. The imaging appearances of central nervous system and musculoskeletal involvement by sickle cell disease have been well documented; however, involvement of the head and neck region is often unreported, although it is not uncommon. In the head and neck, sickle cell disease can involve the inner ears, orbits, paranasal sinuses, bones, lymph nodes and vessels. This paper describes a case of idiopathic facial swelling associated with sickle cell disease in a young patient.
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Affiliation(s)
- Swapnil Moghe
- Department of Oral & Maxillofacial Surgery, People's Dental Academy, Bhopal, Madhya Pradesh, India
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Musculoskeletal manifestations of sickle cell anaemia: a pictorial review. Anemia 2011; 2011:794283. [PMID: 21490766 PMCID: PMC3065899 DOI: 10.1155/2011/794283] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 10/24/2010] [Indexed: 11/17/2022] Open
Abstract
Sickle cell anaemia is an autosomal recessive genetic condition producing abnormal haemoglobin HbS molecules that result in stiff and sticky red blood cells leading to unpredictable episodes of microvascular occlusions. The clinical and radiological manifestations of sickle cell anaemia result from small vessel occlusion, leading to tissue ischemia/infarction and progressive end-organ damage. In this paper we discuss and illustrate the various musculoskeletal manifestations of sickle cell disease focusing primarily on marrow hyperplasia, osteomyelitis and septic arthritis, medullary and epiphyseal bone infarcts, growth defects, and soft tissue changes.
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Saito N, Nadgir RN, Flower EN, Sakai O. Clinical and Radiologic Manifestations of Sickle Cell Disease in the Head and Neck. Radiographics 2010; 30:1021-34. [DOI: 10.1148/rg.304095171] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Collins WO, Younis RT, Garcia MT. Extramedullary hematopoiesis of the paranasal sinuses in sickle cell disease. Otolaryngol Head Neck Surg 2005; 132:954-6. [PMID: 15944571 DOI: 10.1016/j.otohns.2004.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- William O Collins
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Miami School of Medicine, Florida 33136, USA
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Brennan LV, Mayer T, Devitt J. Extramedullary Hematopoiesis Occurring as a Nasal Polyp in a Man with a Myeloproliferative Disorder. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408300414] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We describe the case of a patient with a known myeloproliferative disorder who presented with epistaxis and what clinically appeared to be a nasal polyp. The mass was resected and proved to represent a focus of extramedullary hematopoiesis. The patient subsequently developed extramedullary hematopoiesis of the skin and the stomach wall. Following nasal polypectomy, he did well for a time, but he eventually died as a result of other complications of his disease. This unique case serves as a reminder that common rhinologic complaints can be a sign of significant and life-threatening pathology.
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Affiliation(s)
- Lawrence V. Brennan
- From the Department of Hematology/Oncology, St. Luke Hospital, Fort Thomas. Ky
| | - Thomas Mayer
- From the Department of Hematology/Oncology, St. Luke Hospital, Fort Thomas. Ky
| | - James Devitt
- From the Department of Hematology/Oncology, St. Luke Hospital, Fort Thomas. Ky
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Aronsohn MS, Antonelli PJ, Mancuso A. Extramedullary Hematopoiesis Presenting as a Middle Ear Mass. Otol Neurotol 2003; 24:963-4. [PMID: 14600485 DOI: 10.1097/00129492-200311000-00027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Michael S Aronsohn
- Department of Otolaryngology, University of Florida, Gainesville, Florida 32610-0264, USA
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Koch CA, Li CY, Mesa RA, Tefferi A. Nonhepatosplenic extramedullary hematopoiesis: associated diseases, pathology, clinical course, and treatment. Mayo Clin Proc 2003; 78:1223-33. [PMID: 14531481 DOI: 10.4065/78.10.1223] [Citation(s) in RCA: 203] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To define associated clinical conditions, pathology, natural history, and treatment outcome of nonhepatosplenic extramedullary hematopoiesis (NHS-EMH). PATIENTS AND METHODS We retrospectively reviewed the medical charts of all patients identified as having NHS-EMH from 1975 to 2002. Diagnosis was made by tissue biopsy, fine-needle aspiration biopsy, or radionuclide bone marrow scanning. RESULTS We identified 27 patients with antemortem diagnosis of NHS-EMH. The most common associated condition and disease site were myelofibrosis with myeloid metaplasia (MMM) (in 18 patients [67%]) and the vertebral column (in 7 patients [26%]; all involving the thoracic region), respectively. At the time of diagnosis of NHS-EMH, concurrent splenic EMH (in 22 patients [82%]; 15 [56%] had undergone splenectomy) and red blood cell transfusion dependency (in 12 patients [44%]) were prevalent. Of the 27 patients, 9 (33%) required no specific therapy. Specific therapy was radiation (in 7 patients with a 71% response rate) and surgical excision (in 6 patients with a 67% response). Treatment-associated complications were limited to surgery. Radiation therapy was not used in the non-MMM group, but low-dose radiation therapy was used in the MMM group for paraspinal or intraspinal EMH (median dose, 1 Gy; range, 1-10 Gy), pleural or pulmonary disease (median dose, 1.25 Gy; range, 1.00-1.50 Gy), and abdominal or pelvic disease (median dose, 2.02 Gy; range, 150-4.50 Gy). Median survival after the diagnosis of NHS-EMH was 13 months in the MMM group and 21 months in the non-MMM group. CONCLUSIONS This retrospective study suggests that NHS-EMH is rare, is often associated with MMM, and preferentially affects the thoracic spinal region. Asymptomatic disease may require no specific treatment, whereas symptomatic disease is best managed with low-dose radiation therapy.
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Affiliation(s)
- Cody A Koch
- Mayo Medical School, Mayo Clinic, Rochester, Minn 55905, USA
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Tamiolakis D, PTassopoulos P, Simopoulos C, Kotini A, Venizelos J, Alexiadis G, Manavis J, Papadopoulos N. Renal extramedullary hematopoietic tumor diagnosed by fine needle aspiration: a case report. Acta Clin Belg 2003; 58:299-301. [PMID: 14748097 DOI: 10.1179/acb.2003.58.5.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
UNLABELLED We report a case of a 58 year-old-male with a history of sickle cell anemia, who presented with a left kidney mass. Guided fine needle aspiration of the mass revealed extramedullary hematopoiesis and enabled avoiding an unnecessary surgical procedure. INTRODUCTION Extramedullary hematopoiesis (EMH) generally occurs in patients with deficient bone marrow hematopoiesis secondary to either peripheral red cell destruction or marrow replacement. EMH is most commonly seen in the liver and spleen as a diffuse lesion. Rarely EMH presents as a solitary mass, posing a diagnostic dilemma. In asymptomatic patients without obvious evidence of hemato-pathology, the differential diagnosis is even more complex. Despite several reports describing the radiographic findings in EMH, fewer promote the use of fine needle aspiration (FNA) in making this diagnosis.
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Affiliation(s)
- D Tamiolakis
- Department of Cytology, Democritus University of Thrace, Dragana, 68 100 Alexandroupolis, Greece
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Vargas H, Jennings TA, Galati LT. Unusual Paranasal Sinus Tumors in two Patients with Common Nasal Complaints. EAR, NOSE & THROAT JOURNAL 2001. [DOI: 10.1177/014556130108001010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Common nasal complaints are managed by both the otolaryngologist and the primary care physician. We describe the cases of two patients with nasal obstruction who were referred to us for evaluation—one with severe headache and the other with profuse epistaxis. Their histories prior to referral included long-term, common rhinologic complaints of low-grade headache and mild epistaxis. Neither patient had been referred to us until their symptoms had become severe. Our examination revealed that both patients had rare paranasal sinus pathology. One patient had a fibroxanthoma of the frontal sinus, and the other had extramedullary hematopoiesis of the maxillary sinus. Fibroxanthoma of the frontal sinus is rare, and extramedullary hematopoiesis of the maxillary sinus has not been previously reported. These two unique cases serve as a reminder that long-term common rhinologic complaints can occasionally be a sign of life-threatening pathology and require a full evaluation by an otolaryngologist.
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Affiliation(s)
- Hannah Vargas
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Albany (N.Y.) Medical College
| | - Timothy A. Jennings
- Department of Pathology and Laboratory Medicine, Albany (N.Y.) Medical College
| | - Lisa T. Galati
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Albany (N.Y.) Medical College
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Abstract
Abstract
We investigated the mechanisms of sickle cell disease (SCD) hematopoietic/erythropoietic defects using bone marrow, spleen, and/or peripheral blood from the transgenic SAD mouse model, which closely reproduces the biochemical and physiological disorders observed in human SCD. First, the erythropoietic lineage late precursors (polychromatophilic normoblasts to the intramedullary reticulocytes) of SAD mouse bone marrow were significantly altered morphologically. These anomalies resulted from high levels of hemoglobin polymers and were associated with increased cell fragmentation occurring during medullary endothelial migration of reticulocytes. Secondly, analysis of bone marrow erythropoiesis in earlier stages showed a marked depletion in SAD erythroid burst-forming units (BFU-E; of ∼42%) and erythroid colony-forming units (CFU-E; of ∼23%) progenitors, despite a significant increase in their proliferation, suggesting a compensatory mechanism. In contrast to the bone marrow progenitor depletion, we observed (1) a high mobilization/relocation of BFU-E early progenitors (∼4-fold increase) in peripheral blood of SAD mice as well as of colony-forming units–granulocyte-macrophage (CFU-GM) and (2) a 7-fold increase of SAD CFU-E in the spleen. Third, and most importantly, SAD bone marrow multipotent cells (spleen colony-forming units [CFU-S], granulocyte-erythroid-macrophage-megakaryocyte colony-forming units [CFU-GEMM], and Sca+Lin−) were highly mobilized to the peripheral blood (∼4-fold increase), suggesting that peripheral multipotent cells could serve as proliferative and autologous vehicles for gene therapy. Therefore, we conclude the following. (1) The abnormal differentiation and morphology of late nucleated erythroid precursors result in an ineffective sickle erythropoiesis and likely contribute to the pathophysiology of sickle cell disorders; this suggests that transfer of normal or modified SCD bone marrow cells may have a selective advantage in vivo. (2) A hematopoietic compensatory mechanism exists in SAD/SCD pathology and consists of mobilization of multipotent cells from the bone marrow to the peripheral blood and their subsequent uptake into the spleen, an extramedullary hematopoietic site for immediate differentiation. Altogether, these results corroborate the strong potential effectiveness of both autologous and allogeneic bone marrow transplantation for SCD hematopoietic therapy.
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Abstract
We investigated the mechanisms of sickle cell disease (SCD) hematopoietic/erythropoietic defects using bone marrow, spleen, and/or peripheral blood from the transgenic SAD mouse model, which closely reproduces the biochemical and physiological disorders observed in human SCD. First, the erythropoietic lineage late precursors (polychromatophilic normoblasts to the intramedullary reticulocytes) of SAD mouse bone marrow were significantly altered morphologically. These anomalies resulted from high levels of hemoglobin polymers and were associated with increased cell fragmentation occurring during medullary endothelial migration of reticulocytes. Secondly, analysis of bone marrow erythropoiesis in earlier stages showed a marked depletion in SAD erythroid burst-forming units (BFU-E; of ∼42%) and erythroid colony-forming units (CFU-E; of ∼23%) progenitors, despite a significant increase in their proliferation, suggesting a compensatory mechanism. In contrast to the bone marrow progenitor depletion, we observed (1) a high mobilization/relocation of BFU-E early progenitors (∼4-fold increase) in peripheral blood of SAD mice as well as of colony-forming units–granulocyte-macrophage (CFU-GM) and (2) a 7-fold increase of SAD CFU-E in the spleen. Third, and most importantly, SAD bone marrow multipotent cells (spleen colony-forming units [CFU-S], granulocyte-erythroid-macrophage-megakaryocyte colony-forming units [CFU-GEMM], and Sca+Lin−) were highly mobilized to the peripheral blood (∼4-fold increase), suggesting that peripheral multipotent cells could serve as proliferative and autologous vehicles for gene therapy. Therefore, we conclude the following. (1) The abnormal differentiation and morphology of late nucleated erythroid precursors result in an ineffective sickle erythropoiesis and likely contribute to the pathophysiology of sickle cell disorders; this suggests that transfer of normal or modified SCD bone marrow cells may have a selective advantage in vivo. (2) A hematopoietic compensatory mechanism exists in SAD/SCD pathology and consists of mobilization of multipotent cells from the bone marrow to the peripheral blood and their subsequent uptake into the spleen, an extramedullary hematopoietic site for immediate differentiation. Altogether, these results corroborate the strong potential effectiveness of both autologous and allogeneic bone marrow transplantation for SCD hematopoietic therapy.
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Meara JG, Potter C, Goodman M, Vernick D. Extramedullary hematopoiesis of the middle ear in a patient with thalassemia. Am J Otolaryngol 1998; 19:287-9. [PMID: 9692641 DOI: 10.1016/s0196-0709(98)90134-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- J G Meara
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, USA
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17
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Abstract
A case of tumor-like extramedullary hematopoiesis (EMH) of the liver diagnosed by fine-needle aspiration cytology guided by computer tomography (CT) is reported. The initial clinical diagnosis was metastatic carcinoma from an adrenal gland primary. Five other cases of tumor-like EMH diagnosed by FNA have been presented in the literature. In two of the cases, the primary clinical diagnosis was metastatic tumor. The most common location for tumor-like EMH is paravertebral and intrathoracic. Three such cases of paravertebral tumor-like EMH have been diagnosed by FNA. Nodular EMH can be found rarely in other organs as in the liver.
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Affiliation(s)
- L B Lemos
- Department of Pathology, University of Mississippi Medical Center, Jackson 39216, USA
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