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

Abstract

This case report shows that extramedullary haematopoiesis is very rare and that it is a difficult diagnostic challenge when its location is unusual and when it is not associated with a haematologic disorder. Together with this case report, we present an update of the available diagnostic methods.

A systematic review of presacral extramedullary haematopoiesis: a diagnosis to be considered for presacral masses

“…). Of the remaining 31 articles, there were 37 cases reports of patients with a confirmed presacral EMH . To this group, the two cases presented here were added.…”

“…Fine needle aspiration as opposed to larger biopsy has been used in some cases, but the results may be misleading owing to the presence of atypical megakaryocytes [31]. Several authors suggest that it is reasonable to defer biopsy should imaging be consistent with EMH [21,23,32] when suspicion for malignancy remains low [26], but Vasilliou et al [25] argue that the only definitive way to diagnose EMH is through biopsy. Alternatively, Sarmiento et al [13] and Babazadeh et al [1] suggest diagnostic angiography owing to the hypervascularity of EMH, but no patients in the present review underwent this investigation.…”

“…Biopsy may be a modality that practitioners are more familiar with, which accounts for the high proportion of our study patients who underwent biopsy. Care should be taken to advise patients that while biopsy of EMH masses may be confirmatory there is a risk of bleeding , especially with manipulation of the mass . Fine needle aspiration as opposed to larger biopsy has been used in some cases, but the results may be misleading owing to the presence of atypical megakaryocytes .…”

“…Fine needle aspiration as opposed to larger biopsy has been used in some cases, but the results may be misleading owing to the presence of atypical megakaryocytes . Several authors suggest that it is reasonable to defer biopsy should imaging be consistent with EMH when suspicion for malignancy remains low , but Vasilliou et al . argue that the only definitive way to diagnose EMH is through biopsy.…”

“…Surgery or radiotherapy are rarely necessary unless the patient is symptomatic. Surgical excision risks profuse bleeding and incomplete excision . Radiotherapy has been suggested to be successful through myelosuppression and relief of spinal nerve or cord compression .…”