Tuberc Respir Dis.  2009 Sep;67(3):244-248.

A Case of Extramedullary Hematopoiesis Presenting as a Lung Mass in a Patient with Primary Myelofibrosis

• Kim YM
• Kim HT
• Noh GY
• Kang MS
• Chang YH
• Kim HR
• Lee JC
• Kim CH

Abstract

Primary myelofibrosis is characterized by replacement of bone marrow with fibrotic tissue and the development of extramedullary hematopoiesis. Extramedullary hematopoiesis primarily involves the spleen and liver, but can also occur in the lungs. We report the case of an 80-year-old male who was admitted for evaluation of a lung mass and persistent thrombocytopenia. A percutaneous needle aspiration from the mass in the right lower lung showed myelopoietic cells with fatty tissue. A bone marrow biopsy revealed a hypercellular marrow with an increased number of atypical megakaryocytes. The final diagnosis was a prefibrotic stage of primary myelofibrosis leading to extramedullary hematopoiesis in the lung.

Keyword

Extramedullary hematopoiesis; Primary myelofibrosis; Lung mass

MeSH Terms

Adipose Tissue
Aged, 80 and over
Biopsy
Bone Marrow
Hematopoiesis, Extramedullary
Humans
Liver
Lung
Male
Megakaryocytes
Needles
Primary Myelofibrosis
Spleen
Thrombocytopenia

Figure

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  Figure 1 Chest X-ray findings. An airspace opacity was found in the right lower lung.

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  Figure 2 Chest CT findings. (A) Ground glass opacities and a 3 cm mass were found in the right lower lung. (B) Mild splenomegaly was noted with multiple low attenuated lesion, which are likely foci of extramedullary hematopoiesis.

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  Figure 3 Pathologic findings of percutaneous needle aspiration from the mass in the right lower lung. The myelopoietic cells with fatty tissue were suggestive of extramedullary hematopoiesis (H&E stain, ×400).

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  Figure 4 Peripheral blood smear findings. The platelet number was markedly decreased (Wright-Giemsa stain, ×1,000).

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  Figure 5 Bone marrow biopsy findings. The marrow revealed hypercellularity (>90%) with an increased number of dysplastic megakaryocytes, including megakaryocytes with hypolobulated nuclei (Wright-Giemsa stain, ×400).

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