Massive Ascites Caused by Peritoneal Extramedullary Hematopoiesis as the Initial Manifestation of Myelofibrosis

Nontuberculous mycobacterial infection in a patient with myelofibrosis: case report and concise review

A 70-year-old patient having massive refractory ascites in the course of idiopathic myelofibrosis was diagnosed of peritoneal extramedullary hematopoiesis and developed an overwhelming nontuberculous mycobacterial infection. The case describes this unusual infection and highlights the need for additional studies to confirm the etiology of ascites in primary myelofibrosis.

Normoblasts in pleural fluid: are they significant?

The hemopoietic cell elements in body fluids is a rare encounterance. From among the normal bone marrow inhabitants, only megakaryocytes are occasionally seen in pleural and peritoneal fluids due to extramedullary hemopoiesis as a result of myeloproliferative disorders. The finding of isolated normoblasts in body fluids with no other marrow elements is described here for the first time in pleural fluid from two patients. The normoblasts which have a close resemblance morphologically to mesothelial cells, need to be differentiated from one another. A supravital stain is of help when in doubt. Because of their close resemblance, normoblasts may get missed during evaluation. This report highlights the need for a larger number of positive cases with emphasis on their course details to understand the significance of normoblasts in body fluids.

Pelvic extramedullary haematopoiesis associated with hereditary spherocytosis

Extramedullary haematopoiesis (EMH) is a rare disorder and is characterised by the appearance of haemopoietic tissue outside of the bone marrow. The most common of the previously recognised sites of EMH are the spleen and the liver. This case-report describes a unique case of pelvic EMH secondary to herditary spherocytosis with regression of the lesion following splenectomy. Current principles of managing EMH are also discussed.

Idiopathic myelofibrosis with extramedullary haemopoiesis involving the urinary bladder in a Chinese lady

Extramedullary haemopoiesis (EMH) associated with idiopathic myelofibrosis most commonly involves the reticuloendothelial organs, such as the spleen and liver, although ectopic haemopoietic tissue has also been described rarely in the lymph nodes, skin, gastrointestinal tract, pleura, peritoneum, central nervous system, and genital and urinary tracts. We report on a 54-year-old Chinese lady with a long history of idiopathic myelofibrosis who presented with gross haematuria and left hydronephrosis due to EMH in the bladder trigone. Cystoscopic examination revealed a sessile necrotic papillary growth at the trigone, obstructing the left ureteric orifice. Transurethral resection of the bladder tumour was performed, and microscopic examination of the tumour chips demonstrated atypical megakaryocytes, immature granulocytes and normoblasts, confirming the presence of EMH. The residual bladder tumour responded well to low dose radiotherapy, with subsequent disappearance of haematuria and normalization of ultrasonogram findings.