Extramedullary hematopoiesis presenting as a focal splenic mass: a case report

Abstract

We report the ultrasound, computed tomographic, and magnetic resonance imaging findings in a case of extramedullary hematopoiesis presenting as a focal splenic mass in a patient with myelodysplastic syndrome. Ultrasound demonstrated a well-circumscribed hyperechoic mass, whereas computed tomography showed a heterogeneous mass better visualized after administration of intravenous contrast. On magnetic resonance imaging, the lesion was hypointense to the spleen on T1-weighted images, with increased signal on T2-weighted images, and demonstrated enhancement after intravenous contrast administration. Extramedullary hematopoiesis should be considered in the differential diagnosis for a splenic mass in any patient with a hematologic disorder.

Imaging studies in extramedullary hematopoiesis of the spleen

“…Foci of extramedullary hematopoiesis can be found in various organs, even if it predominantly affects the liver and spleen. The localizations of extramedullary hematopoiesis may be also in the thoracic paravertebral areas, lymph nodes, adrenal gland, retroperitoneal fat, and renal pelvis [3,4].…”

Extramedullary Hematopoiesis in a Man With β-Thalassemia: An Uncommon Cause of an Adrenal Mass

“…The CT scans show it as a non-homogenous lowdensity tumor (3). The MRI, which is another diagnostic modality, the mass has low to intermediate signal on T1-weighted sequence and low to high signal on T2-weighted images (1). Radionuclide bone marrow imaging, with techentium-99m sulfur colloid may be helpful in diagnosis (1,6).…”

“…The MRI, which is another diagnostic modality, the mass has low to intermediate signal on T1-weighted sequence and low to high signal on T2-weighted images (1). Radionuclide bone marrow imaging, with techentium-99m sulfur colloid may be helpful in diagnosis (1,6). Also, biopsy is suggested sometimes to avoid surgery, although it has its own limitations: not reliable and not always safe (8).…”

“…Extramedullary hematopoiesis (EMH) is a compensatory mechanism for deficient formation or function of red blood cells (1). It can present, uncommonly, as a soft tissue mass.…”

Incidental finding of a splenic hamartoma with tumour-like extramedullary erythropoiesis

“…Hamartomas of the spleen with extramedullary erythropoiesis are extremely rare. These lesions can show an association with haemolytic processes like thrombocytopenia and myeloproliferative diseases in some cases, but usually they are asymptomatic and are found incidentally [2][3][4][5][6][7].…”