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Kim, Kim, Noh, Kang, Chang, Kim, Lee, and Kim: A Case of Extramedullary Hematopoiesis Presenting as a Lung Mass in a Patient with Primary Myelofibrosis
Case Report
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(3): 244-248.

Published online: 30 September 2009

DOI: https://doi.org/10.4046/trd.2009.67.3.244

A Case of Extramedullary Hematopoiesis Presenting as a Lung Mass in a Patient with Primary Myelofibrosis

Yeo Myeong Kim, M.D.1, Hyeon Tae Kim, M.D.1, Geum Youb Noh, M.D.1, Min Soo Kang, M.D.1, Yoon Hwan Chang, M.D.2, Hye-Ryoun Kim, M.D.1, Jae Cheol Lee, M.D.1, Cheol Hyeon Kim, M.D.1

1Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.

2Department of Laboratory Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.

Address for correspondence: Cheol Hyeon Kim, M.D. Department of Internal Medicine, Korea Cancer Center Hospital, 215-4, Gongneung-dong, Nowon-gu, Seoul 139-706, Korea. Phone: 82-2-970-1209, Fax: 82-2-970-2438, cheol@kcch.re.kr

Received 29 July 2009       Accepted 2 September 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Primary myelofibrosis is characterized by replacement of bone marrow with fibrotic tissue and the development of extramedullary hematopoiesis. Extramedullary hematopoiesis primarily involves the spleen and liver, but can also occur in the lungs. We report the case of an 80-year-old male who was admitted for evaluation of a lung mass and persistent thrombocytopenia. A percutaneous needle aspiration from the mass in the right lower lung showed myelopoietic cells with fatty tissue. A bone marrow biopsy revealed a hypercellular marrow with an increased number of atypical megakaryocytes. The final diagnosis was a prefibrotic stage of primary myelofibrosis leading to extramedullary hematopoiesis in the lung.

Keywords: Extramedullary hematopoiesis, Primary myelofibrosis, Lung mass

Figures and Tables

Figure 1
Chest X-ray findings. An airspace opacity was found in the right lower lung.
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Figure 2
Chest CT findings. (A) Ground glass opacities and a 3 cm mass were found in the right lower lung. (B) Mild splenomegaly was noted with multiple low attenuated lesion, which are likely foci of extramedullary hematopoiesis.
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Figure 3
Pathologic findings of percutaneous needle aspiration from the mass in the right lower lung. The myelopoietic cells with fatty tissue were suggestive of extramedullary hematopoiesis (H&E stain, ×400).
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Figure 4
Peripheral blood smear findings. The platelet number was markedly decreased (Wright-Giemsa stain, ×1,000).
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Figure 5
Bone marrow biopsy findings. The marrow revealed hypercellularity (>90%) with an increased number of dysplastic megakaryocytes, including megakaryocytes with hypolobulated nuclei (Wright-Giemsa stain, ×400).
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References

1. Bowling MR, Cauthen CG, Perry CD, Patel NP, Bergman S, Link KM, et al. Pulmonary extramedullary hematopoiesis. J Thorac Imaging. 2008. 23:138–141.
2. Koch CA, Li CY, Mesa RA, Tefferi A. Nonhepatosplenic extramedullary hematopoiesis: associated diseases, pathology, clinical course, and treatment. Mayo Clin Proc. 2003. 78:1223–1233.
3. Lund RE, Aldridge NH. Computed tomography of intracranial extramedullary hematopoiesis. J Comput Assist Tomogr. 1984. 8:788–790.
4. MacKinnon S, McNicol AM, Lee FD, McDonald GA. Myelofibrosis complicated by intestinal extramedullary haemopoiesis and acute small bowel obstruction. J Clin Pathol. 1986. 39:677–679.
5. Oh HA, Kang HJ, Lee G, Choi JH, Lee JL, Lee KH, et al. A case of chronic myelogenous leukemia with extramedullary hematopoiesis presenting as liver mass. Korean J Hematol. 2002. 37:80–83.
6. Lee HJ, Hong JH, Kang YH, Seo KS, Seong EY, Yu YI, et al. A case of cutaneous extramedullary hematopoiesis in idiopathic myelofibrosis. Korean J Hematol. 1997. 32:476–480.
7. Goh DH, Lee SH, Cho DC, Park SH, Hwang JH, Sung JK. Chronic idiopathic myelofibrosis presenting as cauda equina compression due to extramedullary hematopoiesis: a case report. J Korean Med Sci. 2007. 22:1090–1093.
8. Kwak HS, Lee JM. CT findings of extramedullary hematopoiesis in the thorax, liver and kidneys, in a patient with idiopathic myelofibrosis. J Korean Med Sci. 2000. 15:460–462.
9. Spivak JL. Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J, editors. Chapter 103. Polycythemia vera and other myeloproliferative diseases. Harrison's principles of internal medicine. 2008. 17th ed. New York: McGraw-Hill Co, Inc.;674–675.
10. Ward HP, Block MH. The natural history of agnogenic myeloid metaplasia (AMM) and a critical evaluation of its relationship with the myeloproliferative syndrome. Medicine (Baltimore). 1971. 50:357–420.
11. Bradford CR, Smith SR, Wallis JP. Pericardial extramedullary hematopoiesis in chronic myelomonocytic leukemia. J Clin Pathol. 1993. 46:674–675.
12. Fielding JR, Owens M, Naimark A. Intrathoracic extramedullary hematopoiesis secondary to B12 and folate deficiency: CT appearance. J Comput Assist Tomogr. 1991. 15:308–310.
13. Asakura S, Colby TV. Agnogenic myeloid metaplasia with extramedullary hematopoiesis and fibrosis in the lung: report of two cases. Chest. 1994. 105:1866–1868.
14. Kopecky KK, Moriarty AT, Antony AC, Baker MK. Extramedullary hematopoiesis in acute lymphocytic leukemia masquerading as hepatic, renal, and splenic microabscesses. AJR Am J Roentgenol. 1986. 147:846–847.
15. Kupferschmid JP, Shahian DM, Villanueva AG. Massive hemothorax associated with intrathoracic extramedullary hematopoiesis involving the pleura. Chest. 1993. 103:974–975.
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