Extramedullary hematopoiesis in a case of rhabdomyosarcoma with bone marrow metastasis

Abstract

Extramedullary hematopoiesis (EMH) occurs in bone marrow failure due to a variety of causes. Although common in hematological disorders like myelofibrosis and hemoglobinopathies, EMH occurring as a result of bone marrow metastasis from solid tumors is very rare. We report a case of EMH subsequent to bone marrow metastasis from parameningeal rhabdomyosarcoma in a 17-year-old girl. The patient presented with anemia and thrombocytopenia. Bone marrow biopsy revealed metastasis from rhabdomyosarcoma. Contrast-enhanced computed tomography (CECT) was performed and revealed an enhancing mass in the left nasal cavity, with adjacent bone erosion suggestive of parameningeal rhabdomyosarcoma. Additionally, multiple homogenously enhancing masses were seen in the paravertebral location, adjoining multiple bilateral ribs, along the anterior surface of the sternum and in the presacral space, suggestive of EMH. Chemotherapy was subsequently started, but the patient developed febrile neutropenia and expired as a result of septic shock.