1
|
Sun H, Zeng GH, Xiong Y. Hidden in the mediastinum: a case of extramedullary hematopoiesis unveiled through thoracoscopy. J Int Med Res 2024; 52:3000605231221088. [PMID: 38190843 PMCID: PMC10775723 DOI: 10.1177/03000605231221088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Extramedullary hematopoiesis (EMH) is a rare condition characterized by proliferation of hematopoietic stem cells outside the bone marrow, usually as a compensatory response to hematological disease. Although EMH primarily occurs in the liver and spleen, it can manifest in atypical locations, such as the mediastinum. We herein describe an asymptomatic 66-year-old man with incidentally discovered posterior mediastinal EMH. A 28- × 32-mm mass was detected during a routine examination. Laboratory findings were within normal limits. Computed tomography revealed a well-defined enhancing mass with a density of 60 Hounsfield units, suggestive of a neurogenic tumor. Surgical resection confirmed EMH, characterized by megakaryocytes and hematopoietic precursors. The patient recovered smoothly and was discharged 5 days postoperatively. Accurate preoperative diagnosis of EMH is challenging, as illustrated by this case. Although typically associated with anemia or hematological abnormalities, EMH can present without such signs. Surgical resection and histopathological examination are essential for diagnosis. This case emphasizes the diagnostic complexity of posterior mediastinal EMH, even in patients without overt hematological disorders. Posterior mediastinal EMH is exceedingly rare and diagnostically demanding. A high index of suspicion and histological tissue analysis are crucial for optimal management. Video-assisted thoracoscopic surgery enables both diagnosis and treatment through mass excision.
Collapse
Affiliation(s)
- Hui Sun
- Department of Thoracic Surgery, Ganzhou People’s Hospital, Ganzhou Hospital Affiliated to Nanchang University, Ganzhou Hospital Affiliated to Nanfang Hospital of Southern Medical University, Ganzhou, China
| | - Gan Hua Zeng
- Department of Thoracic Surgery, Ganzhou People’s Hospital, Ganzhou Hospital Affiliated to Nanchang University, Ganzhou Hospital Affiliated to Nanfang Hospital of Southern Medical University, Ganzhou, China
| | - Yu Xiong
- Department of Thoracic Surgery, Ganzhou People’s Hospital, Ganzhou Hospital Affiliated to Nanchang University, Ganzhou Hospital Affiliated to Nanfang Hospital of Southern Medical University, Ganzhou, China
| |
Collapse
|
2
|
Occhipinti M, Heidinger BH, Franquet E, Eisenberg RL, Bankier AA. Imaging the posterior mediastinum: a multimodality approach. Diagn Interv Radiol 2016; 21:293-306. [PMID: 25993732 DOI: 10.5152/dir.2014.14467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information.
Collapse
Affiliation(s)
- Mariaelena Occhipinti
- Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
| | | | | | | | | |
Collapse
|
3
|
Zhang HZ, Li Y, Liu X, Chen BR, Yao GH, Peng YN. Extramedullary hematopoiesis: A report of two cases. Exp Ther Med 2016; 12:3859-3862. [PMID: 28101170 PMCID: PMC5228087 DOI: 10.3892/etm.2016.3855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/11/2016] [Indexed: 11/22/2022] Open
Abstract
Extramedullary hematopoiesis (EMH) is defined as hematopoiesis occurring in organs outside of the bone marrow. The present report describes two cases of thalassemic patients with paraspinal medullary hematopoiesis and analyzes the clinical manifestations, imaging, pathology, diagnosis and treatment of EMH. In addition, a supplementary review of previously published cases is provided along with a review of the related literature. Computed tomography (CT) of the first case revealed multiple paraspinal masses, and the largest was 6.2×8.0 cm in diameter. Likewise, CT of the second patient revealed multiple paraspinal masses in the bottom of the left thoracic cavity, and the largest was measured 10.1×10.5 cm. The two cases underwent surgical biopsy and the findings were compatible with a diagnosis of EMH. In conclusion, EMH is a compatible and rare disease, and should be distinguished from other neoplasms. EMH must considered when masses with characteristic radiologic appearance are detected in patients with thalassemia intermedia.
Collapse
Affiliation(s)
- Huan-Zhu Zhang
- Oncology Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 100044, P.R. China
| | - Ying Li
- Oncology Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 100044, P.R. China
| | - Xin Liu
- Oncology Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 100044, P.R. China
| | - Bao-Rong Chen
- Oncology Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 100044, P.R. China
| | - Guo-Hua Yao
- Oncology Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 100044, P.R. China
| | - Yu-Na Peng
- Oncology Department, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 100044, P.R. China
| |
Collapse
|
4
|
Ahmad K, Ansari S, Koirala R, Agarwal M, Chaudhary S. Paraspinal and presacral extramedullary hematopoiesis: a rare manifestation of polycythemia vera. IRANIAN JOURNAL OF RADIOLOGY 2013; 10:164-8. [PMID: 24348604 PMCID: PMC3857981 DOI: 10.5812/iranjradiol.4297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 05/23/2012] [Accepted: 06/20/2012] [Indexed: 02/05/2023]
Abstract
Extramedullary hematopoiesis is characterized by the presence of hematopoietic tissue outside the bone marrow. Extrathoracic extramedullary hematopoiesis is a rare and usually asymptomatic condition. We report a case of a 38-year-old female with paraspinal and presacral extramedullary hematopoiesis with polycythemia vera. Clinical and laboratory evaluation, along with radiological and histopathological findings are described. The diagnosis of the disease was confirmed by CT-guided biopsy. Review of literature is presented.
Collapse
Affiliation(s)
- Kaleem Ahmad
- Department of Radiodiagnosis, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
- Corresponding author: Kaleem Ahmad, Department of Radiodiagnosis, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Tel.: +91-9973888910, E-mail:
| | - Sajid Ansari
- Department of Radiodiagnosis, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Roshan Koirala
- Department of Radiodiagnosis, Nobel Medical College, Nepal
| | - Meenu Agarwal
- Department of Pathology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Shatdal Chaudhary
- Department of Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| |
Collapse
|
5
|
Cherington C, Schuster SR, Kundranda M, Valdez R, Mesa RA, Northfelt DW. A surprising cause of masses in the chest. Am J Hematol 2013; 88:518-21. [PMID: 23076627 DOI: 10.1002/ajh.23343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 09/11/2012] [Accepted: 09/17/2012] [Indexed: 11/12/2022]
Abstract
An 82-year-old male presented to the emergency department with an acute onset of chest pain and mild shortness of breath at rest. The pain in his left lower chest was pleuritic with intensity 9- on a 10-point scale. He had driven 2 h in his car that day, but had no other prolonged immobility. About 15 years previously, he was found to have increased hemoglobin (18.1 g/dL) and diagnosed with secondary erythrocytosis due to active smoking, chronic obstructive pulmonary disease (COPD), and residence in Payson, Arizona (altitude 4,999 ft). Polycythemia vera was entertained, but not pursued due to multiple secondary risks. He had been treated with daily aspirin and monthly phlebotomies to maintain a hematocrit below 45%. He also had a history of superficial thrombophlebitis, nephrolithiasis, hypertension and superficial transitional cell carcinoma of the bladder resected and in remission. There was also a deep venous thrombosis (DVT) and pulmonary embolism (PE) 13 years previously, believed to be provoked by prolonged immobility after a radical prostatectomy for prostate cancer now in remission. His medications were aspirin and lisinopril; he had no known drug allergies. He quit smoking 2 years prior after a 70 pack-year history. There was no other family history of thrombosis or bleeding disorder, autoimmune disorders, pulmonary disease or malignancy.
Collapse
Affiliation(s)
- Chad Cherington
- Department of Internal Medicine; Mayo Clinic; Scottsdale; Arizona
| | | | | | - Riccardo Valdez
- Department of Laboratory Medicine and Pathology; Mayo Clinic; Scottsdale; Arizona
| | - Ruben A. Mesa
- Division of Hematology/Oncology; Mayo Clinic; Scottsdale; Arizona
| | | |
Collapse
|
6
|
Paraspinal extramedullary hematopoiesis in patients with thalassemia intermedia. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2010; 19:871-8. [PMID: 20204423 DOI: 10.1007/s00586-010-1357-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 02/04/2010] [Accepted: 02/21/2010] [Indexed: 10/19/2022]
Abstract
Ineffective erythropoiesis in patients with thalassemia intermedia drives extramedullary hematopoietic tumor formation in several parts of the body. Paraspinal involvement has received increasing attention due to the associated morbidity secondary to spinal cord compression. Although the history and physical examination may help narrow the differential diagnosis, radiographic imaging remains essential to confirm the existence of hematopoietic tissue. Characteristic appearance has been observed mainly on magnetic resonance imaging. Several treatment options have been described, including transfusion therapy, laminectomy, radiotherapy, and the use of fetal hemoglobin inducing agents that decrease the hematopoietic drive. However, the ideal management scheme remains controversial. Until large prospective trials evaluate the efficacy and safety of the available treatment options, both in single and in combination therapy, an individualized approach should be entertained.
Collapse
|
7
|
Dewan U, Kumari N, Jaiswal A, Behari S, Jain M. Extramedullary hemopoiesis with undiagnosed, early myelofibrosis causing spastic compressive myelopathy: Case report and review. Indian J Orthop 2010; 44:98-103. [PMID: 20165685 PMCID: PMC2822429 DOI: 10.4103/0019-5413.57281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Extramedullary hemopoiesis (EMH) is a common compensatory phenomenon associated with chronic hemolytic anemia. Abnormal hemopoietic tissue usually develops in sites responsible for fetal hemopoiesis, such as spleen, liver and kidney; however, other regions such as the spine may also become involved. In this study, a patient presenting with spastic paraparesis due to EMH in the dorsal spine is described. A 62-year-old man presented with paraparesis. Magnetic resonance imaging revealed a large lesion involving the T2-L2 vertebral levels with a large extradural component causing thecal sac compression. Laminectomy with excision of mass was carried out. The histopathology revealed EMH. The patient had no known cause for EMH at the time of diagnosis but, subsequently, a bone marrow examination revealed early myelofibrosis. This case represents the rare occurrence of a large extradural extramedullary hematopoiesis in a patient with no known predisposing factor for hemopoiesis at the time of presentation.
Collapse
Affiliation(s)
- Udita Dewan
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Niraj Kumari
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Awadesh Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Manoj Jain
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
8
|
Tsitsopoulos P, Zevgaridis D, Tsitsopoulos P, Tsonidis C, Anagnostopoulos I, Marinopoulos D. Lumbar nerve root compression due to extramedullary hemopoiesis in a patient with thalassemia: complete clinical regression with radiation therapy. Case report and review of the literature. J Neurosurg Spine 2007; 6:156-60. [PMID: 17330584 DOI: 10.3171/spi.2007.6.2.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The authors describe the case of a 24-year-old woman who had a history of beta3-thalassemia and presented with severe symptoms of lumbar nerve root compression due to extramedullary hemopoiesis in the intervertebral foramen. Radiation therapy (2000 cGy in six fractions) was delivered to the mass. The patient's neurological symptoms completely resolved following treatment. Follow-up images showed a reduction in lesion size. The results of this unique case supported by a review of the literature suggest that radiation therapy alone is an effective modality in the treatment of patients with compression of neural structures due to extramedullary hemopoietic tissue.
Collapse
Affiliation(s)
- Philippos Tsitsopoulos
- Department of Neurosurgery, Medical School of Aristotle University, Hippokration Hospital, Thessaloniki, Greece
| | | | | | | | | | | |
Collapse
|
9
|
Jalbert F, Chaynes P, Lagarrigue J. Asymptomatic spherocytosis presenting with spinal cord compression. J Neurosurg Spine 2005; 2:491-4. [PMID: 15871492 DOI: 10.3171/spi.2005.2.4.0491] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Extramedullary hematopoiesis (EMH) is a compensatory mechanism occurring in patients with chronic anemia, which occurs most frequently with thalassemia. The authors report the case of a 57-year-old man, with no history of clinical or hematological disease, presenting with spinal cord compression. Magnetic resonance (MR) imaging demonstrated a homogeneous posterior epidural mass extending from T-3 to T-6. Following decompressive surgery, the patient's symptoms improved. Histological analysis showed features consistent with a diagnosis of EMH. Subsequent workup was remarkable for an asymptomatic spherocytosis without anemia. There was no family history of anemia. An EMH-related presentation of mild spherocytosis has been described in the literature, but its epidural location led to spinal cord compression. The MR imaging features were suggestive of EMH, but in the presence of spinal cord compression and in the absence of a history of chronic anemia, the authors did not believe that nonsurgical management would have been reasonable.
Collapse
|
10
|
Chute DJ, Fowler DR. Fatal Hemothorax Due to Rupture of an Intrathoracic Extramedullary Hematopoietic Nodule. Am J Forensic Med Pathol 2004; 25:74-7. [PMID: 15075694 DOI: 10.1097/01.paf.0000113859.48471.49] [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: 10/26/2022]
Abstract
Intrathoracic extramedullary hematopoiesis (TEMH) is an unusual but well-described entity, which is typically found in patients who have chronic hemolytic anemias, myelofibrosis, or myeloproliferative disorders. It is seldom symptomatic, rarely fatal. We report a case of a 26-year-old African-American male with a past medical history of sickle cell trait/beta thalassemia who developed multiple intrathoracic nodules of extramedullary hematopoiesis. One of these nodules spontaneously ruptured and produced a fatal hemothorax.
Collapse
Affiliation(s)
- Dennis J Chute
- Division of Neuropathology, UCLA Medical Center, Los Angeles, California 90095, USA.
| | | |
Collapse
|
11
|
Salehi SA, Koski T, Ondra SL. Spinal cord compression in beta-thalassemia: case report and review of the literature. Spinal Cord 2004; 42:117-23. [PMID: 14765145 DOI: 10.1038/sj.sc.3101544] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A case report of thoracic spinal cord compression in a 34-year-old male with beta-thalassemia is reported. OBJECTIVES In patients with thalassemia, neurologic complaints should lead to a high index of suspicion for spinal cord compression from marrow expansion, ectopic bone formation and resultant stenosis. Initial presentation, diagnosis, radiographic findings, surgical treatment and follow-up are reviewed. SETTING This case is reported from Chicago, Illinois. METHOD A chart review is performed for the purposes of this case report. RESULTS Patient underwent decompressive laminectomy with good surgical outcome. CONCLUSION Rapid diagnosis and treatment of such a condition is essential to optimize the chances of recovery.
Collapse
Affiliation(s)
- S A Salehi
- Department of Neurological Surgery, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | | |
Collapse
|
12
|
À vous couper le souffle et les jambes. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80643-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|