Extramedullary Haematopoiesis Presenting with Backache and Paraparesis - A Case Report

A 49-year-old female patient was admitted in the medicine department of Assam Medical College with complaints of paraparesis of 15 days duration and backache of 3 months’ duration. She had history of dizziness and low blood pressure. On general examination, she had tachycardia (heart rate of 126 beats / min), tachypnoea (respiratory rate 24 / min), severe pallor and bilateral non-pitting pedal oedema. The patient had low haemoglobin (6.6 gm / dl) with red blood cell (RBC) count of 2.5 million / mm3 . She was sent to the radio-diagnosis department for non-contrast computed tomography (CT) scan of thorax and contrast enhanced magnetic resonance (CEMR) of dorsolumbar region. On CT scan, soft tissue density lesions were noted in paraspinal region extending from lower thoracic, lumbar region without destruction of vertebral bodies. Additional findings include hepato-splenomegaly and left sided pleural effusion. On CEMR, there was T1 hypo and T2 / T2FSisointense soft tissue lesion in paraspinal region extending from lower thoracic, lumbar and sacral vertebrae. The lesions were showing diffusion restriction, diffusion weighted imaging (DWI) with low apparent diffusion coefficient (ADC) value and mild enhancement on post contrast scan. The soft tissue component was noted to extend into the epidural space in multiple vertebral levels in thoracic, lumbar and sacral regions causing spinal canal stenosis, maximum (7.0 mm) at L4 vertebral level. Based on the imaging findings, a diagnosis of extramedullary haematopoiesis in paraspinal region with extension of the soft tissue in the epidural space leading to compression of spinal cord at multiple levels was made.

Adrenal extramedullary haematopoiesis: an unusual incidentaloma

We report a case of adrenal extramedullary haematopoiesis in a 24-year-old women who presented with pallor and weakness. Ultrasonography of the abdomen detected moderate hepatosplenomegaly with multiple lesions in the spleen and an incidental right adrenal mass. There was no ascites or lymphadenopathy. CT scan revealed a heterogeneous right adrenal mass with multiple non-enhancing lesions in the spleen. Ultrasound guided trucut biopsy was performed after excluding a functioning tumour, which confirmed the diagnosis. Later, she was diagnosed to have haemoglobin E/beta thalassaemia and was put on hydroxyurea trial.

Extramedullary haematopoiesis presenting as a periportal mass

Extramedullary haematopoiesis (EMH) is defined as haematopoiesis occurring in organs outside the bone marrow. The liver is one of the rare sites of EMH, and to the best of our knowledge, a few cases of adult EMH of the liver have been reported in the last 20 years. Here, we reported the case of a 68-year-old man with a known history of myelofibrosis presented with vague abdominal pain. An abdominal CT scan showed a hypoattenuating periportal mass encasing the portal vein. The final diagnosis of EMH was made through the histopathological examination. This is a rare presentation of EMH, which may be easily mistaken for other pathologies such as metastases. Familiarity with this type of presentation aids in correctly diagnosing it in an appropriate clinical setting.

Rare case of focal mass like perirenal extramedullary haematopoiesis in a renal transplant recipient

Extramedullary haematopoiesis (EMH) is a physiological process of formation of blood cells outside the bone marrow in response to insufficient production or excessive destruction of blood cells. Most common sites of EMH are liver, spleen, lymph nodes, kidney and paraspinal regions. In this report, we have described a rare case of focal EMH which presented as a mass adjacent to the renal allograft. Imaging characteristics favoured a benign aetiology with MRI signals suggesting the presence of blood and fatty components. The final diagnosis of EMH was made by aspiration cytology and an unnecessary surgery was thus avoided.