Korean J Radiol.  2008 Jul;9(Suppl):S34-S38. 10.3348/kjr.2008.9.s.s34.

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

• Lee IJ
• Kim SH
• Kim DS
• Lee JM
• Han JK
• Choi BI

• KMID: 1100101
• DOI: http://doi.org/10.3348/kjr.2008.9.s.s34

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.

Keyword

Liver; Extramedullary hematopoiesis; Magnetic resonance (MR); Superparamagnetic iron oxide; Kupffer cell

MeSH Terms

Adenoma/*diagnosis
Adult
Diagnosis, Differential
*Hematopoiesis, Extramedullary
Humans
Liver/*physiology
Liver Neoplasms/*diagnosis
*Magnetic Resonance Imaging
Male
Primary Myelofibrosis/physiopathology

Figure

• 

  Fig. 1 Intrahepatic extramedullary hematopoiesis in 33-year-old woman. A. 33-year-old woman with history of idiopathic myelofibrosis. On contrast-enhanced CT obtained in equilibrium phase, 2-cm-sized, well-defined and homogeneously enhancing mass (arrow) is seen in segment VI of liver. Liver and spleen are diffusely enlarged. B. Lesion (arrow) shows homogeneous low signal intensity on in-phase T1-weighted image (repetition time [TR]/echo time [TE] = 140 msec/2.4 msec, flip angle [FA] = 70°). C. Lesion (arrow) shows high signal intensity on fat-saturated, T2-weighted fast spin echo image (TR/TE = 12,857.1/100.7). D. On serial gadolinium-BOPTA dynamic MR scans, lesion (arrows) shows homogeneous and intense enhancement on arterial phase (20 seconds after gadolinium administration, upper right) compared with pre-contrast T1-weighted image (TR/TE = 4.7/2.2, FA = 10°) (upper left); it enhances persistently through portal (50 seconds, lower left) to delayed phases (5 minutes, lower right). E. On SPIO-enhanced, T2*-weighted gradient echo image (TR/TE = 130.0/9.7, FA = 30°) obtained 10 minutes after SPIO administration, there is no signal drop in lesion (arrow). F. On the photomicrograph (Hematoxylin & Eosin staining; ×200), megakaryocytes (arrow) and pleomorphic groups of erythroid and myeloid precursors that represent three hematologic precursor cell-lines, are seen insinuating hepatocyte cords. G. Immunohistochemical staining using CD68 marker (×40), reveals that cells in extramedullary hematopoiesis are positive for CD 68 (stained with brown color), but degree of staining in lesion (lower part of dotted line) is much weaker than that in normal liver (upper part of dotted line).

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