Extramedullary hematopoiesis involving the thyroid: Fine-needle aspiration features and literature review

Been, Laura; Ogden, Lorna; Traweek, S. Thomas

doi:10.1016/j.jasc.2015.10.002

Cited by 7 publications

(9 citation statements)

References 10 publications

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“…Extramedullary hematopoiesis is defined by the presence of immature hematopoietic cells in sites other than bone marrow, which is extremely rare in the thyroid gland. 11 There are some theories considering EMH as a possible result of heterotopic bone formation arising in long-standing dystrophic calcifications 12…”

Section: Discussionmentioning

confidence: 99%

Multifocal papillary carcinoma of the thyroid with heterotopic ossification and extramedullary hematopoiesis associated with a lipomatous follicular nodule

et al. 2019

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Heterotopic ossification has been described in papillary thyroid carcinoma in association with high incidence of extrathyroidal invasion, multifocality, lymph node metastasis, and older age. Nevertheless, it has not been described as a specific subtype of papillary thyroid carcinoma, because of its rarity. We described the case of an 80-year-old female patient, with familial history of papillary thyroid carcinoma. In the annual screening examination, she was diagnosed with thyroid nodules. The patient was submitted to a thyroidectomy because the fine needle aspiration cytology was positive for malignancy according to the Bethesda classification. The surgical specimen analyses showed a multifocal papillary carcinoma with one major lesion in the left lobe measuring 0.9 cm, and two small lesions (0.4 cm and 0.2 cm) in the right lobe. Only the biggest lesion in the right lobe had the osteoid matrix with rare osteoclasts and fat metaplasia with progenitor cells. There was perineural invasion, but vascular invasion was not identified. The margins were free and there was no extrathyroidal extension. In the left lobe there was an oncocytic nodule and a lipomatous follicular nodule. In recent years there has been a significant increase in the diagnosis of thyroid cancer, mainly because of the finding of microcarcinomas as a result of many requests for cervical image exams. Future studies may define (i) whether papillary thyroid carcinoma with heterotopic ossification is a true histological variant; (ii) the causes of that alteration; and (iii) eventual follow-up implications.

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Section: Discussionmentioning

confidence: 99%

Multifocal papillary carcinoma of the thyroid with heterotopic ossification and extramedullary hematopoiesis associated with a lipomatous follicular nodule

et al. 2019

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“…1,2 While the entity of EMH and its associated conditions have long been recognized, the specific mechanisms giving rise to EMH are unknown and remain as postulates. 1,[15][16][17][18][19][20][21] Herein, we describe a patient with myelofibrosis who presented with neurologic complaints, was found to have intracranial lesions by imaging studies, and in whom CSF cytology supported a diagnosis of intracranial EMH. 5,6 Intracranial EMH is extremely rare and such patients can present with headache, papilledema, visual-field defects, seizures, and hydrocephalus, or be asymptomatic.…”

Section: Introductionmentioning

confidence: 93%

“…[7][8][9][10][11][12][13][14] While EMH has been diagnosed from various cytology specimens, including fine needle aspirations, body cavity effusions, and peritoneal washings, we can find only one previous case report where EMH was diagnosed in cerebrospinal fluid (CSF). 1,[15][16][17][18][19][20][21] Herein, we describe a patient with myelofibrosis who presented with neurologic complaints, was found to have intracranial lesions by imaging studies, and in whom CSF cytology supported a diagnosis of intracranial EMH.…”

Section: Introductionmentioning

confidence: 99%

A common complication of myelofibrosis presenting as a rare finding in cerebrospinal fluid cytology

Ruíz-Cordero

Jorgensen

Krishnamurthy

et al. 2017

Diagnostic Cytopathology

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Herein, we present a rare case of intracranial extramedullary hematopoiesis (EMH) diagnosed by cerebrospinal fluid (CSF) cytology and describe the clinical presentation, radiologic, and pathologic findings. A 65 year-old man with a history of progressing primary myelofibrosis was admitted for headaches and right facial numbness. A brain MRI revealed focal abnormalities that were suspicious for leptomeningeal involvement of acute leukemia. Cytologic examination of CSF demonstrated a hypercellular specimen composed of hematopoietic cells including few blasts, as well as maturing red blood cells and granulocytic cells. The integration of morphologic findings, peripheral blood and bone marrow counts, as well as flow cytometric analysis of CSF and bone marrow, excluded leptomeningeal involvement by leukemic blasts and helped establish the diagnosis of intracranial EMH. Inclusion of EMH in the differential diagnosis of intracranial pathology in patients with known conditions predisposing them to EMH is important because recognizing this rare event has implications for treatment and prognosis.

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“…It is typically seen in organs vigorously involved in fetal hematopoiesis, including liver, spleen, and lymph nodes [8,9] . Rarely, it can also be seen in other sites including epidural space, adrenal, pleural, and thyroid [10,11] . EMH in epidural space is a rare and particularly sensitive location as it can cause spinal compression and may present as a paravertebral pseudotumor presenting as back pain and neurological disorder of the lower limbs.…”

Section: Introductionmentioning

confidence: 99%

“…[ 8 , 9 ] Rarely, it can also be seen in other sites including epidural space, adrenal, pleural, and thyroid. [ 10 , 11 ] EMH in epidural space is a rare and particularly sensitive location as it can cause spinal compression and may present as a paravertebral pseudotumor presenting as back pain and neurological disorder of the lower limbs. Treatment options vary and include blood transfusions, radiotherapy, and decompressive surgery, with different responses and recurrence rates.…”

Section: Introductionmentioning

confidence: 99%

Recurrent spinal cord compression due to extramedullary hematopoiesis in thalassemia patient

et al. 2022

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Introduction:Spinal cord compression secondary to extramedullary hematopoiesis (EMH) is a rare condition. Variable treatment options have been reported with different efficacy and recurrence rate. Due to its rarity, no clear optimal management guidelines have been established yet.Patient concerns and diagnosis:We report a recurrence of spinal cord compression secondary to EMH in a 19-year-old male, with a background of transfusion-dependent beta-thalassemia on luspatercept, who presented with weakness in both lower limbs.Interventions and outcomes:He was treated successfully both times with radiotherapy.Conclusion:Early diagnosis and management of EMH compressing the spinal cord are essential to prevent permanent neurological damage. Diagnosis should be suspected based on the clinical presentation and magnetic resonance imaging findings in a patient with a history of ineffective hemopoiesis. Treatment option remains controversial. Radiotherapy option seems effective, even in recurrent cases, and valid, particularly for those at high risk of surgery or who do not prefer it.

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Extramedullary hematopoiesis involving the thyroid: Fine-needle aspiration features and literature review

Cited by 7 publications

References 10 publications

Multifocal papillary carcinoma of the thyroid with heterotopic ossification and extramedullary hematopoiesis associated with a lipomatous follicular nodule

Multifocal papillary carcinoma of the thyroid with heterotopic ossification and extramedullary hematopoiesis associated with a lipomatous follicular nodule

A common complication of myelofibrosis presenting as a rare finding in cerebrospinal fluid cytology

Recurrent spinal cord compression due to extramedullary hematopoiesis in thalassemia patient

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