A Clinical and Pathological Study of Seventy Cases of Myelofibrosis

Renal extramedullary hematopoiesis: interstitial and glomerular pathology

“…Although not seen in our series, renal extramedullary hematopoiesis has been associated with renal calculi, related to high cell turnover and increased urates from the underlying hematological process. 12 The other main indication for biopsy in this series was proteinuria and, indeed, most biopsies with extramedullary hematopoiesis showed a concurrent glomerular disease: fibrillary-like glomerulonephritis, chronic thrombotic microangiopathy, focal segmental glomerulosclerosis, or nodular diabetic glomerulosclerosis. The glomerular disease patterns other than diabetic glomerulosclerosis are likely related to the renal extramedullary hematopoiesis or the underlying hematologic malignancy.…”

“…24 Extrinsic infiltration (as noted in 50% of our cases) can also cause hydronephrosis and hydroureter with resultant obstructive uropathy and acute renal failure. 12,14 In some situations, as seen in patient 8, both processes may occur. Renal dysfunction might also be attributed to the hematologic process rather than the extramedullary hematopoiesis.…”

A Rare Presentation of Extramedullary Hematopoiesis in Post-polycythemic Myelofibrosis

“…Among chronic myeloproliferative disorders, EMH is most commonly seen in idiopathic MF since it is associated with the highest rate of bone marrow fibrosis (up to 80 % at presentation) and circulating progenitor cells [5,6]. Foci of EMH are most commonly found in the spleen, liver and lymph nodes, but may also infrequently occur at other sites as kidney, adrenal glands, pleura and peritoneum [7][8][9][10][11]. Skin and cardiac manifestations, as we have encountered in our patient, are extremely rare.…”

Focal intrahepatic extramedullary hematopoiesis mimicking neoplasm

“…Although hematopoiesis becomes more immature with progression of the disease, neoplastic proliferation with destruction or invasion of the hepatic cords is never seen and fibrosis is minimal [6]. Although macroscopic nodular foci of hematopoietic cells are occasionally found on autopsy examination of the liver and spleen [7,8], only two cases have been reported in which liver architecture was grossly distorted because of massive impaction of the sinusoids with hematopoietic cells [7]. In two other cases, extensive necrosis and hemorrhage were due to viral hepatitis.…”

“…Pathologically, other than the liver, spleen, and lymph nodes, reported sites of extramedullary hematopoiesis indude the kidney, adrenal glands, gastrointestinal tract, lung and pleura, heart, retroperitoneum, skin, breast, dura mater, ovary, epididymis, and thymus [6,8]. …”