Video-assisted thoracoscopic surgery for intrathoracic extramedullary hematopoiesis

Abstract

Extramedullary hematopoiesis is a rare cause of an intrathoracic mass in individuals with hemolytic disorders. It can be clinically confused with other tumors of the mediastinum. While radiologic studies often demonstrate findings suggesting intrathoracic extramedullary hematopoiesis, histology is usually required for diagnostic purposes. Thoracotomy was the mainstay procedure for obtaining tissue diagnosis and resection. However, video-assisted thoracoscopy (VATS) is an amendable and less-invasive means of tumor removal. We report a case of a posterior mediastinal extramedullary hematopoietic mass in a forty-two year old male in which VATS was utilized for diagnosis and resection.

Surgical resection of extramedullary haematopoiesis in the posterior mediastinum

“…It was hypothesized that extramedullary haematopoiesis occurs to compensate for haemolytic anaemia caused by spherocytosis, thalassemia, and hereditary spherocytosis, or as a reaction to abnormal bone marrow function seen in disorders such as myelofibrosis and leukaemia or due to the activation of embryonic haematopoietic stem cells at other sites . Although extramedullary haematopoiesis frequently occurs in the liver, spleen, and lymph nodes, it can rarely occur in the posterior mediastinum . Asymptomatic patients with posterior mediastinum extramedullary haematopoiesis usually require no treatment, and management usually depends on the patient’s symptoms .…”

“…The liver and spleen are common sites for extramedullary haematopoiesis. However, it has been reported in other locations such as the posterior mediastinum . It is difficult to differentiate extramedullary haematopoiesis from other tumours, such as neurogenic tumours, in the posterior mediastinum because radiological studies and other less invasive investigations can be limited.…”