Intrahepatic Extramedullary Hematopoiesis Mimicking a Hypervascular Hepatic Neoplasm on Dynamic- and SPIO-Enhanced MRI

Abstract

We present a rare case of a focal intrahepatic extramedullary hematopoiesis (EMH) that mimicked a hypervascular hepatic neoplasm in a 33-year-old woman with idiopathic myelofibrosis. The lesion showed homogeneous and persistent enhancement on both contrast-enhanced CT and gadolinium-enhanced dynamic MR imaging. The lesion did not demonstrate an apparent signal drop on a T2*-weighted sequence following administration of a superparamagnetic iron-oxide agent (SHU 555A). A hepatocellular adenoma was the initial radiological diagnosis. To the best of our knowledge, this is the first report of a histopathologically proven intrahepatic EMH evaluated with dynamic- and SPIO-enhanced MRI.

Unusual focal intrahepatic extramedullary haematopoiesis in alpha‐thalassaemia

“…EMH usually shows microscopic involvement and generally results in diffuse hepatosplenomegaly, although, in rare cases, the involvement can manifest as a mass‐like lesion. Focal EMH rarely involves the liver alone . In our case, the definitive diagnosis was obtained with 52 Fe‐scintigraphy, avoiding invasive bioptic procedures.…”

The role of T2*-weighted gradient echo in the diagnosis of tumefactive intrahepatic extramedullary hematopoiesis in myelodysplastic syndrome and diffuse hepatic iron overload: a case report and review of the literature

“…For instance, Resovist® (SHU 555A) has the strongest affinity to Kupffer cells, and the least affinity to macrophages in bone marrow. At least one instance of a weak or even no signal loss of intrahepatic EMH has been reported which was thought to be in part due to the low affinity of Resovist® to marrow macrophages [ 1 ].…”

“…In adults, extramedullary hematopoiesis (EMH) is seen in the setting of marrow-occupying lesions like myelofibrosis, myeloproliferative disorders, and carcinoma with extensive bone marrow metastasis and in the setting of increased cell turnover (for example, chronic hemolytic anemia) [ 1 – 3 ]. The most common sites of EMH in the abdomen are the liver and spleen; and when involving the liver and spleen, EMH most commonly presents as hepatosplenomegaly [ 2 ].…”

Hepatobiliary Pseudotumors Consisting of Nonneoplastic Hematopoietic Cells and Cells of the Macrophage Lineage

“…In pediatric patients, EMH is considered normal up to about 5 weeks of age. Nodular extramedullary hematopoiesis of the liver (NEMH-L) occurs in the form of solitary or multiple lesions of highly variable size, involving one or both liver lobes (Kopecky et al 1986;Wiener et al 1987;Abbitt and Teates 1989;Dewar et al 1990;Bradley and Metreweli 1990;Warshauer and Schiebler 1991;Kumar et al 1995;Tamm et al 1995;Lemos et al 1997;Aytac et al 1999;Wong et al 1999;Kwak and Lee 2000;Navarro et al 2000;Hervé et al 2001;Gil-Fernandez et al 2001;Parwani and Ali 2003;Tamiolakis et al 2004;Gupta et al 2004;Jelali et al 2006;Lee et al 2008). Among eight cases with sufficient data compiled from the literature, five were multiple and three solitary lesions (Wong et al 1999).…”

“…CT shows fairly well-defined, homogeneously low attenuated masses. On contrast-enhanced portal venous phase CT, most of the lesions show intense enhancement (Wong et al 1999; Kwak and Lee 2000;Lee et al 2008). The appearance of the lesions on MR consists of slightly increased signal on T2-weighted images with heterogeneous enhancement of some of the lesions during bolus infusion of gadolinium, while the T1-weighted images post-gadolinium showed no delayed enhancement (Warshauer and Schiebler 1991;Jelali et al 2006).…”