Extramedullary hematopoiesis (EMH) occurs as a compensatory mechanism when bone marrow function is insufficient to meet the circulatory needs. EMH is most usually detected in the reticuloendothelial system, which includes the spleen, liver, and lymph nodes, as well as para-osseous locations. With fewer than ten cases recorded, EMH in the adrenal is unusual, and appearing as a large adrenal tumour is extremely rare. We describe the cases of two 38-year-old women who have had -thalassemia since childhood. After hormonal secretion was ruled out, computed tomography (CT) revealed a massive right adrenal mass with heterogeneous density that resembled a tumour mass with significant splenomegaly. An ultrasound-guided biopsy revealed fibrocollagenous tissue with trilineage hemopoiesis in favour of adrenal EMH, ruling out cancer. The therapy for a huge mass included excision surgery followed by repeated transfusions to avoid recurrence. In everyday practise, practitioners should pay special attention to the differential diagnosis in any patient with persistent hematologic abnormalities indicative of EMH, regardless of location. A confirmed preoperative biopsy is indicated to avoid needless treatments.
Author(S) Details
ELaouni Soukaina
Department of Pathology, Ibn Sina University Hospital, Rabat, Morocco and Faculty of medicine and Pharmacy, University Mohamed V, Rabat, Morocco
Znati Kaoutar
Department of Pathology, Ibn Sina University Hospital, Rabat, Morocco and Faculty of medicine and Pharmacy, University Mohamed V, Rabat, Morocco.
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