Extramedullary Hematopoiesis Manifesting as a Symptomatic Pleural Effusion

Bartlett, Rachelina P.; Greipp, Philip R.; Tefferi, Ayalew; Cupps, Roger E.; Mullan, Brian P.; Trastek, Victor F.

doi:10.4065/70.12.1161

Cited by 71 publications

(35 citation statements)

References 22 publications

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“…The hematopoietic tissue is highly radiosensitive, so low-dose radiation has been offered as an effective method to control symptomatic spinal cord compression [8] and haemothorax [2,3,9].Surgical literature suggests that invasive measures be reserved for evacuation of clot, debulking of a mass causing compressive symptoms, or if a diagnosis cannot be made by other modalities [9]. The surgical literature also suggests that sclerotherapy should be contraindicated in these patients because the inflammation caused by the sclerosing agent may cause irritation of the EMH tissue leading to continuous bleeding [9].…”

Section: Discussionmentioning

confidence: 99%

“…beta thalassaemia, sickle cell anaemia, and hereditary spherocytosis) [1]. EMH usually affects the liver, spleen, and lymph nodes, while the intrathoracic cavity is less frequently involved [2,3]. Here, we describe a patient with multiple myeloma who was evaluated for autologous hematopoietic stem cell transplantation (auto-HSCT), presenting with an incidental mass on the chest wall suggesting relapsed disease.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary Extramedullary Hematopoiesis Mimicking Plasmacytoma in a Patient with Multiple Myeloma

Baldane

Şıvgın

Kaynar

et al. 2015

Romanian Journal of Internal Medicine

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A 42-year-old male patient was admitted to our hospital for planning autologous hematopoietic stem cell transplantation (auto-HSCT). He was diagnosed as multiple myeloma (IgG type Kappa) in 2003. His physical examination was normal with no important abnormality on laboratory evaluation. Chest radiography performed for routine evaluation prior to transplantation revealed a large, welldefined mass, that had obtuse angles with the chest wall consistent with extraparenchymal lesion superposed on second and third ribs. Also, there were multiple bony structures demonstrating changes of destructive effects of multiple myeloma. Computed tomography (CT)-guided biopsy was obtained from the mass by transthoracic fine-needle aspiration (FNAB) method. Biopsy was reported as extramedullary hematopoiesis (EMH) contrary to our expectation of multiple myeloma.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pulmonary Extramedullary Hematopoiesis Mimicking Plasmacytoma in a Patient with Multiple Myeloma

Baldane

Şıvgın

Kaynar

et al. 2015

Romanian Journal of Internal Medicine

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“…Low-dose irradiation is very effective for EMH. Paraspinal/epidural masses can be treated with 1000 cGy in 5-10 fractions while pleural and peritoneal effusions can be resolved with 100-500 cGy in 5-10 fractions (2,74,75).…”

Section: Treatment For Extramedullary Hematopoiesismentioning

confidence: 99%

Myelofibrosis with Myeloid Metaplasia: New Developments in Pathogenesis and Treatment

2004

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Myeloid metaplasia with myelofibrosis (MMM) is a chronic myeloproliferative disorder (CMPD) characterized by progressive anemia, massive splenomegaly, both hepatosplenic and non-hepatosplenic extramedullary hematopoiesis (EMH), a leukoerythroblastic blood smear, circulating progenitor cells, and marked bone marrow stromal reaction including collagen fibrosis, osteosclerosis and angiogenesis. The overall median survival is 5 years although it might range from 2 to 15 years depending on the presence or absence of clinically defined prognostic factors. Death is often due to leukemic transformation, portal hypertension or infection. In addition to shortened survival, quality of life is often affected by frequent red blood cell transfusions, profound constitutional symptoms, and cachexia. Drug therapy and autologous hematopoietic stem cell transplantation (HSCT) are of only palliative value and have not been shown to improve survival. The role of allogeneic HSCT, both myeloablative and non-myeloablative, is actively being investigated. Both splenectomy and radiation therapy have defined therapeutic roles to control EMH-associated symptoms. Analysis of the molecular biology of the disease is underway with the aid of animal models leading to the identification of novel therapeutic targets. Among the novel agents tested, thalidomide seems the most promising although newer agents are on the horizon.

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“…Low-dose irradiation remains the treatment of choice for extramedullary haematopoiesis (EMH) at other sites, Guideline ª 2012 Blackwell Publishing Ltd including involvement of the peritoneum and pleura with resultant ascites and pleural effusions, respectively (Leinweber et al, 1991;Kupferschmid et al, 1993;Bartlett et al, 1995). External beam radiotherapy is also effective for the involvement of vital organs, including the lung, central nervous system and liver (Price & Bell, 1985;Landolfi et al, 1988;Tefferi et al, 2001b;Steensma et al, 2002).…”

Section: Radiotherapymentioning

confidence: 99%

Guideline for the diagnosis and management of myelofibrosis

et al. 2012

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SummaryThe guideline group regarding the diagnosis and management of myelofibrosis was selected to be representative of UK-based medical experts, together with a contribution from a single expert from the USA. MEDLINE and EMBASE were searched systematically for publications in English from 1966 until August 2011 using a variety of key words. The writing group produced the draft guideline, which was subsequently revised by consensus of the members of the General Haematology and Haemato-oncology Task Forces of the British Committee for Standards in Haematology (BCSH). The guideline was then reviewed by a sounding board of UK haematologists, the BCSH and the British Society for Haematology Committee and comments incorporated where appropriate. The criteria used to state levels and grades of evidence are as outlined in the Procedure for Guidelines commissioned by the BCSH; the 'GRADE' system was used to score strength and quality of evidence. The objective of this guideline is to provide healthcare professionals with clear guidance on the investigation and management of primary myelofibrosis, as well as post-polycythaemic myelofibrosis (post-PV MF) and post-thrombocythemic myelofibrosis (post-ET MF) in both adult and paediatric patients.

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Extramedullary Hematopoiesis Manifesting as a Symptomatic Pleural Effusion

Cited by 71 publications

References 22 publications

Pulmonary Extramedullary Hematopoiesis Mimicking Plasmacytoma in a Patient with Multiple Myeloma

Pulmonary Extramedullary Hematopoiesis Mimicking Plasmacytoma in a Patient with Multiple Myeloma

Myelofibrosis with Myeloid Metaplasia: New Developments in Pathogenesis and Treatment

Guideline for the diagnosis and management of myelofibrosis

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