Exceptional localization of extramedullary hematopoiesis: presacral and periureteral masses

Abstract

We report an exceptional case of periureteral and presacral localizations of extramedullary hematopoiesis. To our knowledge, the association of presacral or periureteral masses has not been described before. Diagnosis was suggested by the association of computed tomography (CT) imaging findings and knowledge of the clinical context. Guided CT biopsy is a safe and efficient means to obtain final diagnosis of atypical extramedullary hematopoiesis localizations.

Presacral extramedullary haematopoiesis: A diagnostic update and case report of a late diagnosis

“…Authors describe rapid response with this regime. 6,10,13 In patients with spinal cord compression, neurological improvement has been achieved within 3-7 days of treatment initiation. 2 Surgical treatment is contraindicated in EMH, but it may be useful for immediate symptomatic relief.…”

“…11 A diffuse enhancement is described when administering gadolinium. 7,10,[12][13][14] Al-Aabassi and Murad use MRI as the technique of choice to diagnose EMH. 10 However, MRI has been known to misinterpret EMH as a neurogenic tumour.…”

Extramedullary Hematopoiesis: Cytomorphologic, Histologic, and Radiologic Findings in Sixteen Cases

“…EMH is found in the liver, spleen and, rarely, in the lymph nodes, as these organs are primarily responsible for hematopoiesis in the fetus. However, there are scattered reports of EMH presenting in the presacral region, adrenal glands, pleura, pericardium, chest cavity, thymus, epididymis, peripheral nerves, cartilage, adipose tissue, breasts and spinal medulla [1,4,5,6,28,29]. Theories on EMH histogenesis are controversial, with the most widely accepted being that an unknown stimulatory factor switches on latent hematopoietic precursors in the spleen [30].…”

“…However, it can essentially occur in any organ. It may present as a mass-forming lesion and can simulate a malignant neoplasm clinically and radiologically [1,2,3,4,5,6]. In addition, the megakaryocytes can mimic malignant neoplastic cells, thus raising the cytomorphologic differential diagnosis to include metastatic carcinoma, Hodgkin lymphoma, non-Hodgkin lymphoma and myeloid sarcoma.…”

Mass-like extramedullary hematopoiesis: imaging features

“…Multiple case reports have described EMH in virtually every tissue of the human body, including the adrenal gland, thymus, kidney, pleura, pulmonary interstitium, breast, skin, gastrointestinal tract, and dura mater [1,[4][5][6]. Previous reports have also documented the existence and appearance of mass-like involvement, which may mimic a soft tissue neoplasm [4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Despite these reports, little attention has been paid to the overall spectrum of imaging findings in EMH and the frequency, distribution, and appearance of mass-like change.…”