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CASE REPORT Table of Contents   
Year : 2010  |  Volume : 44  |  Issue : 1  |  Page : 98-103
Extramedullary hemopoiesis with undiagnosed, early myelofibrosis causing spastic compressive myelopathy: Case report and review


1 Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
2 Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Click here for correspondence address and email

Date of Web Publication31-Dec-2009
 

   Abstract 

Extramedullary hemopoiesis (EMH) is a common compensatory phenomenon associated with chronic hemolytic anemia. Abnormal hemopoietic tissue usually develops in sites responsible for fetal hemopoiesis, such as spleen, liver and kidney; however, other regions such as the spine may also become involved. In this study, a patient presenting with spastic paraparesis due to EMH in the dorsal spine is described. A 62-year-old man presented with paraparesis. Magnetic resonance imaging revealed a large lesion involving the T2-L2 vertebral levels with a large extradural component causing thecal sac compression. Laminectomy with excision of mass was carried out. The histopathology revealed EMH. The patient had no known cause for EMH at the time of diagnosis but, subsequently, a bone marrow examination revealed early myelofibrosis. This case represents the rare occurrence of a large extradural extramedullary hematopoiesis in a patient with no known predisposing factor for hemopoiesis at the time of presentation.

Keywords: Extramedullary hemopoiesis, myelofibrosis, spastic paraparesis, spine

How to cite this article:
Dewan U, Kumari N, Jaiswal A, Behari S, Jain M. Extramedullary hemopoiesis with undiagnosed, early myelofibrosis causing spastic compressive myelopathy: Case report and review. Indian J Orthop 2010;44:98-103

How to cite this URL:
Dewan U, Kumari N, Jaiswal A, Behari S, Jain M. Extramedullary hemopoiesis with undiagnosed, early myelofibrosis causing spastic compressive myelopathy: Case report and review. Indian J Orthop [serial online] 2010 [cited 2019 Dec 9];44:98-103. Available from: http://www.ijoonline.com/text.asp?2010/44/1/98/57281

   Introduction Top


Extramedullary hemopoiesis (EMH) may occur in various types of hemodyscrasia and dyshemopoiesis as a common compensatory phenomenon associated with chronic hemolytic anemia. [1],[2] Abnormal hemopoietic tissue usually develops in sites responsible for fetal hemopoiesis, such as spleen, liver, lymph nodes and kidney; however, other regions such as the spine may also become involved. [1],[2] In patients with thalassemia and other hemoproliferative disorders, EMH may occasionally lead to progressive spastic myelopathy. [1],[2],[3] In the present study, however, spinal thecal and cord compression as a consequence of EMH in the intraspinal epidural space initially manifested without any primary cause. Asymptomatic myelofibrosis in the early stages was subsequently detected on bone marrow examination. In this study, a patient presenting with spastic paraparesis due to EMH in the dorsal spine has been described.


   Case Report Top


A 62-year-old male patient presented with progressive, spastic paraparesis over a period of 4 months with complaints of tightness in the bilateral lower limbs, progressive difficulty in walking and band-like sensation at the level of the nipples. He complained of numbness of the bilateral lower limbs, frequency of micturition and constipation for 1 month. He had a history of cervical lymphadenopathy 2 years back for which he took antituberculous treatment (isoniazid, rifamycin, pyrizinamide and ethambutol) for 9 months. He was a known hypertensive for the last 9 months.

His general physical and systemic examinations were unremarkable. On neurological examination, his higher mental functions and cranial nerve examination were normal. The motor system examination revealed spastic paraparesis with Medical Research Council grade 0 at the hip and knee and grade 2 movement at the ankle and toes. Superficial abdominal reflexes were absent and bilateral plantar reflexes were extensors. The sensory examination revealed 50-70% sensory loss of all modalities below the T4 level, including posterior column sensation impairment in both lower limbs. A diffuse spinal tenderness was present in the mid dorsal spine and the flexion-extension movements of the dorsal spine were restricted and painful. The clinical impression was that of an extradural compressive myelopathy with T4 spinal cord level.

His routine blood investigations revealed hemoglobin of 10.3 gm% and total leukocyte count of 9,300 cells/mm 3 , with differential leukocyte count of neutrophils (71%) and lymphocytes (29%). A few nucleated red blood cells (RBCs) were noted in the peripheral smear along with findings of anisopoikilocytosis, few tear drop cells and polychromatophilic RBCs.

A magnetic resonance imaging (MRI) of the dorsal spine revealed a large lesion involving the T2-L2 vertebral levels. The lesion was hypointense on T1- and isointense on T2-weighted images with a large extradural component. It caused thecal sac and spinal cord compression with T2-signal intensity changes within the cord [Figure 1]a and b. There was no evidence of caseation or necrosis within the lesion. Plain radiographs were not performed before surgery.

The patient was planned for a T2-L2 laminectomy with excision of the mass. During surgery, the epidural veins were engorged. The veins and the mass bled profusely during surgical dissection. The extradural lesion was soft, pinkish and friable. A peroperative impression of lymphoma was considered. The patient was anemic in the post-operative course, with the post-operative hemoglobin being 6.4 gm%. Multiple blood transfusions and oral hematinics were administered. The patient was discharged on the seventh post-operative day.

The histopathology of the lesion showed a vaguely nodular collection of hematopoietic cells comprising of various stages of erythroid cells, myeloid cells and megakaryocytes with an intertraversing sinusoidal capillary network [Figure 2]a. A histolological confirmation was obtained by staining these sections with periodic acid Schiff stain for megakaryocytes and chloroacetate esterase for myeloid cells, respectively. The megakaryocytes showed magenta-colored cytoplasmic positivity with periodic acid Schiff stain and the myeloid cells showed brownish, granular cytoplasmic positivity with chloroacetate staining.

A diagnosis of extramedullary hematopoeisis was established on the basis of characteristic morphology of hematopoietic cells and their confirmation after histochemical stains. A bone marrow examination was carried out to ascertain the cause of anemia and extramedullary hematopoeisis. The bone marrow biopsy revealed hypercellular marrow with erythroid hyperplasia and megakaryocytic clustering with ectatic sinusoids. The megakaryocytes showed evidence of dysplasia manifested by nucleomegaly, coarse chromatin and absence of nuclear lobation. Reticulin staining showed focally increased fibrosis [Figure 2]b. These findings were suggestive of early myelofibrosis and a close follow-up was advised. On follow-up after 2 months, a Technetium 99 colloid scan and denatured RBC nuclear scan of the liver and spleen were performed, which revealed normal liver and spleen scan findings with no evidence of extramedullary hematopoeisis in these organs. At follow-up after 1.5 months, the patient showed grade 3 power in both lower limbs with residual spasticity. He did not report for a subsequent follow-up and did not undergo a repeat MRI.


   Discussion Top


EMH refers to the presence of hemopoietic elements in locations other than the bone marrow medullary space. It may be seen in many conditions, including chronic anemias, blood dyscrasias such as leukemia or as an incidental finding. The common sites of involvement are the liver, spleen and the lymph nodes. Less common sites include the central nervous system, adrenal gland, kidney, perirenal soft tissues, breast, peritoneal surfaces and gastrointestinal tract. [4],[5],[6],[7] The paraspinal region is a relatively uncommon location for these hemopoietic deposits. There are a few case reports of EMH occurring in the spine. [1],[2],[3],[8] Most cases have been reported in connection with thalassemia, although it has also been described in patients with sickle cell anemia, myelofibrosis and polycythemia vera and myelodysplastic syndrome. [9],[10],[11] To the best of our knowledge, there are very few documented case reports in the literature of patients with myelofibrosis who developed cord compressive symptoms due to EMH in the spine. [8],[10] The patients had myelofibrosis of almost 10 years duration. We report the rare case of a 62-year-old male patient who was diagnosed with compressive symptoms due to solitary EMH in the epidural space. At the time of the appearance of his clinical manifestations due to EMH, he did not have any manifestations of the primary disease that could be responsible for the development of his EMH. The diagnosis of the coexisting, early stages of myelofibrosis (that was essentially asymptomatic) could only be established on subsequent bone marrow examination. There was no evidence of EMH in the liver and spleen in our patient. In all the other reported cases of EMH secondary to myelofibrosis, the manifestations of myelofibrosis precede the development of EMH by several decades.

The source of the epidural hemopoietic tissue in EMH is controversial. There may be rests of primitive hemopoietic stem cells that later expand under extreme hematologic stress present in patients with severe chronic anemia; or, blood-forming elements in the vertebral marrow may be extruded through weakened trabecular bone into the epidural compartment where they may proliferate. Epidural lymphoma, metastases and tuberculosis may show a similar picture.

MRI and nuclear scans delineate ectopic foci of hemopoietic tissue in addition to precisely defining the location, size and extent of the lesion. In our case, however, EMH could not be detected at any other site.

Idiopathic myelofibrosis (IMF) implies fibrosis of the bone marrow in the absence of any associated disease. The average age at diagnosis is 60 years. Splenomegaly due to EMH is a distinctive feature of IMF. The splenomegaly is secondary to myeloid metaplasia. The degree of splenic hemopoiesis has been shown to be directly associated with the duration of the disease. [12] In a study by Andreasan, 13 of 56 cases of IMF did not have splenomegaly. [13] Six of 100 patients with IMF reviewed by Bouroncle and Doan did not have splenomegaly at the time of diagnosis. [14] They stated that during the course of the disease, progressive enlargement of the spleen is a rule. Pitcock et al. noted that two of 70 patients did not have splenomegaly at the time of diagnosis of IMF. [15] No follow-up of these patients without splenomegaly has been mentioned in these reports. There has been only one case report of a patient with IMF of 8 years duration with lack of splenomegaly. In the present reported case, the patient may have been in the stage of early fibrosis, which can explain the absence of splenomegaly and anemia at the time of diagnosis. Even 2 months after the diagnosis, no evidence of EMH or splenomegaly was found by nuclear scan and imaging.

No definite guidelines have as yet been formulated for the treatment of such patients with EMH. Excision and decompression, radiotherapy, hypertransfusion and hydroxyurea alone or in combination have been proposed. These lesions are extremely vascular (as seen in our patient) and hemorrhage in patients with chronic anemia has several risks of cardiovascular debility. Incomplete resection and a high incidence of recurrence are also frequently observed. Radiotherapy has shown a good response in a recent review of spinal EMH. [16]

The reported patients in the literature are summarized in [Table 1] given as additional material on journal website. The most common causes of EMH included thalassemia, polycytemia, hereditary spherocytosis, sickle cell anemia and myelofibrosis. According to the literature, both surgery and radiotherapy have been administered with reasonable results, although recurrences may occur. [3],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45],[46],[47],[48],[49],[50],[51],[52],[53],[54],[55],[56],[57],[58],[59],[60],[61],[62],[63],[64],[65],[66],[67],[68],[69] In our patient, myelofibrosis was asymptomatic and there was no anemia. Therefore, extradural long-segment EMH may have been the primary pathology associated with early myelofibrosis and was not consequent to the anemia produced by myelofibrosis, as has usually been reported in the literature.

To conclude, the unique findings of extensive, solitary EMH of the spine leading to spastic paraparesis with coexistence of early stages of asymptomatic myelofibrosis and the absence of anemia may point toward the rare possibility that EMH and myelofibrosis in our patient had a concurrent association and that EMH had not developed as a compensatory phenomenon consequent to myelofibrosis.

 
   References Top

1.Tai SM, Chan JS, Ha SY, Young BW, Chan MS. Successful treatment of spinal cord compression secondary to extramedullary haemopoietic mass by hypertransfusion in a patient with thalassemia major. Pediatr Hematol Oncol 2006;23:317-21.  Back to cited text no. 1      
2.Niggeman P, Krings T, Hans F, Thron A. Fifteen-year follow-up of a patient with beta thalassaemia and extramedullary haematopoietic tissue compressing the spinal cord. Neuroradiology 2005;47:263-6.  Back to cited text no. 2      
3.Salehi SA, Koski T, Ondra SL. Spinal cord compression in beta-thalassemia: Case report and review of the literature. Spinal Cord 2004;42:117-23.  Back to cited text no. 3      
4.Hiradfur M, Zabolinejadm N, Banihashem A, Kajbafzadeh AM. Renal splenic heterotopia with extramedullary haemopoiesis in a thalassemic patient, simulating renal neoplasm: A case report. J Pediatr Hematol Oncol 2007;29:195-7.  Back to cited text no. 4      
5.Sauer B, Buy X, Gangi X, Roy C. Exceptional localization of extramedullary haemopoiesis: Presacral and periureteral masses. Acta Radiol 2007;48:246-8.  Back to cited text no. 5      
6.Wang J, Darveshian F. Extramedullary haemopoiesis in breast after neoadjuvant chemotherapy for breast carcinoma. Ann Clin Lab Sci 2006;36:475-8.  Back to cited text no. 6      
7.Ayyildiz O, Isikdogan A, Celik M, Muftuoglu E. Intracranial meningeal extramedullary haemopoiesis inducing serious headache in a patient with idiopathic myelofibrosis. J Pediatr Hematol Oncol 2004;26:28-9.  Back to cited text no. 7      
8.De Klippel N, Dehou MF, Bourgain C, Schots R, De Keyser J, Ebinger G. Progressive paraparesis due to thoracic extramedullary haemopoiesis in myelofibrosis. J Neurosurg 1993;79:125-7.  Back to cited text no. 8      
9.Ohtsubo M, Hayashi K, Fukushima T, Chiyoda S, Takahara O. Case report: Intracranial extramedullary haemopoiesis in postpolycythemic myelofibrosis. Br J Radiol 1994;67:299-302.  Back to cited text no. 9      
10.de Backer AI, Zachιe P, Vanschoubroeck IJ, Mortelι KJ, Ros PR, Kockx MM. Extramedullary paraspinal haemopoiesis in hereditary spherocytosis. JBR-BTR 2002;85:206-8.  Back to cited text no. 10      
11.Dibbern DA Jr, Loevner LA, Lieberman AP, Salhany KE, Freese A, Marcotte PJ. MR of thoracic cord compression caused by epidural extramedullary haemopoiesis in myelodysplastic syndrome. AJNR Am J Neuroradiol 1997;18:363-6.  Back to cited text no. 11      
12.Ward H, Block M. The natural history of angiogenic myeloid metaplasia (AMM) and a critical evaluation of its relationship with myeloproliferative syndrome. Medicine 1971;50:357-420.  Back to cited text no. 12      
13.Cheng DS. Idiopathic myelofibrosis without splenomegaly. Cancer 1979;43:1761-5.  Back to cited text no. 13      
14.Bouroncle BA, Doan CA. Myelofibrosis: Clinical, hematologic and pathologic study of 110 patients. Am J Med Sci 1962;243:697-715.  Back to cited text no. 14      
15.Pitcock, JA, Reinhard EH, Justus BW, Mendelsohn RS. A clinical and pathologic study of 70 cases of myelofibrosis. Ann. Intern Med 1962;57:73-84.  Back to cited text no. 15      
16.Tsitsopoulos P, Zevgaridis D, Tsitsopoulos P, Tsonidis C, Anagnostopoulos I, Marinopoulos D. Lumbar nerve root compression due to extramedullary hemopoiesis in a patient with thalassemia: Complete clinical regression with radiation therapy. J Neurosurg Spine 2007;6:156-60.  Back to cited text no. 16      
17.Luyendijk W, Went L, Schaad HD. Spinal cord compression due to extramedullary hematopoiesis in homozygous thalassemia: Case report. J Neurosurg 1975;42:212-6.  Back to cited text no. 17      
18.Cromwell LD, Kerber C. Spinal cord compression by extramedullary hematopoiesis in myeloid metaplasia. Radiology 1978;128:118.  Back to cited text no. 18      
19.Stahl SM, Ellinger G, Baringer JR. Progressive myelopathy due to extramedullary hematopoiesis: Case report and review of the literature. Ann Neurol 1979;5:485-9.  Back to cited text no. 19      
20.Rice GP, Assis LJ, Barr RM, Ebers GC. Extramedullary hematopoiesis and spinal cord compression complicating polycythemia rubra vera. Ann Neurol 1980;7:81-4.  Back to cited text no. 20      
21.Oustwani MB, Kurtides ES, Christ M, Ciric I. Spinal cord compression with paraplegia in myelofibrosis. Arch Neurol 1980;37:81-4.  Back to cited text no. 21      
22.Ahmed F, Tobin MS, Cohen DF, Gomez-Leon G. Beta thalassemia: Spinal cord compression. NY State J Med 1981;81:1505-8.  Back to cited text no. 22      
23.Julien J, Broustet A, Trojani M, Riemens V, Lagueny A, Reiffers J, et al. Spinal cord compression by extramedullary hematopoiesis in chronic eosinophilic leukemia. Sem Hop 1981;57:598-600.   Back to cited text no. 23      
24.Abassioun K, Amir-Jamshidi A. Curable paraplegia due to extradural hematopoietic tissue in thalassemia. Neurosurgery 1982;11:804-7.  Back to cited text no. 24      
25.Luitjes WF, Braakman R, Abels J. Spinal cord compression in a new homozygous variant of beta- thalassemia. J Neurosurg 1982;57:846-8.  Back to cited text no. 25      
26.Heffez DS, Sawaya R, Udvarhelyi GB, Mann R. Spinal epidural extramedullary hematopoiesis with cord compression in a patient with refractory sideroblastic anemia; Case report. J Neurosurg 1982;57:399-406.  Back to cited text no. 26      
27.Lewkow LM, Shah I. Sickle cell anemia and epidural extramedullary hematopoiesis. Am J Med 1984;76:748-51.   Back to cited text no. 27      
28.Price F, Bell H. Spinal cord compression due to extramedullary hematopoiesis: Successful treatment in a patient with long-standing myelofibrosis. JAMA 1985;253:2876-7.  Back to cited text no. 28      
29.Mann KS, Yue CP, Chan KH, Ma LT, Ngan H. Paraplegia due to extramedullary hematopoiesis in thalassemia: Case report. J Neurosurg 1987;66:938-40.  Back to cited text no. 29      
30.Jackson Jr DV, Randall ME, Richards F. Spinal cord compression due to extramedullary hematopoiesis in thalassemia: Long term follow-up after radiotherapy. Surg Neurol 1988;29:389-92.  Back to cited text no. 30      
31.Pagθs A, Pagθs M, Ramos J. Compression of the cauda equina due to extramedullary hematopoiesis. Ann Pathol 1988;8:61-3.  Back to cited text no. 31      
32.Jackson A, Burton IE. Retroperitoneal mass and spinal cord compression due to extramedullary haemopoiesis in polycythemia rubra vera. Br J Radial 1990;42:91-2.  Back to cited text no. 32      
33.Papavasiliou C, Gouliamos A, Vlahos L, Trakadas S, Kalovidouris A, Pouliades G. CT and MRI of symptomatic spinal involvement by extramedullary hematopoiesis. Clin Radiol 1990;42:91-2.  Back to cited text no. 33      
34.Kaufman T, Coleman M, Giardina P, Nisce LZ. The role of radiation therapy in management of hematopoietic neurologic complications in thalassemia. Acta Haematol 1991;85:156-9.  Back to cited text no. 34      
35.Singounas EG, Sakas DE, Hadley DM, Chalevelakis G, Sfakianos G, Raptis S, et al. Paraplegia in a pregnant thalassemic woman due to extramedullary hematopoiesis: Successful management with transfusions. Surg Neurol 1991;36:210-5.  Back to cited text no. 35      
36.Hassoun H, Lawn-Tsao L, Langevin ER Jr, Lathi ES, Palek J. Spinal cord compression secondary to extramedullary hematopoiesis: A noninvasive management based on MRI. Am J Hematol 1991;37:201-3.  Back to cited text no. 36      
37.Amir-Jamshidi A, Abbassioun K, Ketabchi SE. Spinal extradural hematopoiesis in adolescents with thalassemia: Report of two cases and a review of the literature. Childs Nerv Syst 1991;7:223-5.  Back to cited text no. 37      
38.Singhal S, Sharma S, Dixit S, De S, Chander S, Rath GK,Mehta VS. The role of radiation therapy in the management of spinal cord compression due to extramedullary hematopoiesis in thalassemia. J Neurol Neurosurg Psychiatry 1992;55:310-2.  Back to cited text no. 38      
39.Pantongrag-Brown L, Suwanwela N. Case report: Chronic spinal cord compression from extramedullary haematopoiesis in thalassemia - MRI findings. Clin Radiol 1992;46:281-3.  Back to cited text no. 39      
40.McDonald AC, Cook G, Sharp RA, Bissett D. Spinal cord compression in myelofibrosis: A case report. Acta Oncol 1993;32:692-3.  Back to cited text no. 40      
41.Dore F, Pardini S, Gaviano E, Longinotti M, Bonfigli S, Rovasio S, et al. Recurrence of spinal cord compression from extramedullary hematopoiesis in thalassemia intermedia treated with low doses of radiotherapy. Am J Hematol 1993;44:148.  Back to cited text no. 41      
42.Vlahos L, Trakadas S, Gouliamos A, Plataniotis G, Papavasiliou C. Retrocrural masses of extramedullary hemopoiesis in beta-thalassemia. Magn Reson Imaging 1993;11:1227-9.  Back to cited text no. 42      
43.Lau SK, Chan CK, Chow YY. Cord compression due to extramedullary haemopoiesis in a patient with thalassemia. Spine 1994;19:2467-70.  Back to cited text no. 43      
44.Shin KH, Sharma S, Gregoritch SJ, Lifeso RM, Bettigole R, Yoon SS. Combined radiotherapeutic and surgical management of a spinal cord compression by extramedullary hematopoiesis in a patient with hemoglobin E beta thalassemia. Acta Haematol 1994;91:154-7.  Back to cited text no. 44      
45.Cook G, Sharp RA. Spinal cord compression due to extramedullary haemopoiesis in myelofibrosis. J Clin Pathol 1994;47:464-5.  Back to cited text no. 45      
46.Gouliamos AD, Plataniotis GA, Michalopoulos ES, Vlahos LJ, Papavasiliou CG. Case report: magnetic resonance imaging of spinal cord compression in thalassemia before and after radiation treatment. Clin Radiol 1995;50:504-5.  Back to cited text no. 46      
47.Parsa K, Oriezy A. Nonsurgical approach to paraparesis due to extramedullary hematopoiesis: Report of two cases. J Neurosurg 1995;82:657-60.  Back to cited text no. 47      
48.de Morais JC, Spector N, Lavrado FP, Nobre LF, de Mattos JP, Pulcheri W, et al. Spinal cord compression due to extramedullary hematopoiesis in the proliferative phase of polycythemia vera. Acta Haematol 1996;96:242-4.   Back to cited text no. 48      
49.Guermazi A, Miaux Y, Chiras J. Imaging of spinal cord compression due to thoracic extramedullary haematopoiesis in myelofibrosis. Neuroradiology 1997;39:733-6.  Back to cited text no. 49      
50.O'Connor JF, Levinthal GN, Sheets R, Mullen KD. Spinal extramedullary hematopoiesis secondary to hepatocellular carcinoma: Case report and literature review. J Clin Gastroenterol 1997;25:466-9.   Back to cited text no. 50      
51.Aydingφz U, Oto A, Cila A. Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI. Neuroradiology 1997;39:870-2.  Back to cited text no. 51      
52.Munn RK, Kramer CA, Arnold SM. Spinal cord compression due to extramedullary hematopoiesis in beta-thalassemia intermedia. Int J Radiat Oncol Biol Phys 1998;42:607-9.  Back to cited text no. 52      
53.Martνnez-Rodrigo MA, Sanjuanbenito L, Rodrνguez del Barrio E, Martνnez-San Millαn J, Saldaρa D. Spinal cord compression secondary to epidural extramedullary hematopoiesis in thalassemia: A clinical case and review of literature. Rev Neurol 1998;27:998-1004.  Back to cited text no. 53      
54.Phupong V, Uerpairojkij B, Limpongsanurak S. Spinal cord compression: A rareness in pregnant thalassemic woman. J Obstet Gynaecol Res 2000;26:117-20.  Back to cited text no. 54      
55.Chourmouzi D, Pistevou-Gompaki K, Plataniotis G, Skaragas G, Papadopoulos L, Drevelegas A. MRI findings of extramedullary haemopoiesis. Eur Radiol 2001;11:1803- 6.  Back to cited text no. 55      
56.Boyacigil S, Ali A, Ardiη S, Yόksel E. Epidural extramedullary haemopoiesis in thalassaemia. Australas Radiol 2002;46:180-2.  Back to cited text no. 56      
57.Tan TC, Tsao J, Cheung FC. Extramedullary haemopoiesis in thalassemia intermedia presenting as paraplegia. J Clin Neurosci 2002;9:721-5.  Back to cited text no. 57      
58.Haran M, Ni S. Recurrent reversible paraplegia. Lancet 2001;357:1092.  Back to cited text no. 58      
59.Chehal A, Aoun E, Koussa S, Skoury H, Koussa S, Taher A. Hypertransfusion: A successful method of treatment in thalassemia intermedia patients with spinal cord compression secondary to extramedullary hematopoiesis. Spine (Phila Pa 1976) 2003;28:E245-9.  Back to cited text no. 59      
60.Mutijima E, Hmissa S, Ziadi S, Mlaiki A, Mokni M, Korbi S. Cord compression secondary to extramedullary hematopoiesis in a patient with beta-thalassaemia. Rev Med Liege 2005;60:41-4.  Back to cited text no. 60      
61.Jalbert F, Chaynes P, Lagarrigue J. Asymptomatic spherocytosis presenting with spinal cord compression: Case report. J Neurosurg Spine 2005;2:491-4.  Back to cited text no. 61      
62.Malik M, Pillai LS, Gogia N, Puri T, Mahapatra M, Sharma DN, et al. Paraplegia due to extramedullary hematopoiesis in thalassemia treated successfully with radiation therapy. Haematologica 2007;92:28-30.  Back to cited text no. 62      
63.Goh DH, Lee SH, Cho DC, Park SH, Hwang JH, Sung JK. Chronic idiopathic myelofibrosis presenting as cauda equina compression due to extramedullary hematopoiesis: A case report. J Korean Med Sci 2007;22:1090-3.  Back to cited text no. 63      
64.Keikhaei B, Zandian K, Rahim F. Existence of cord compression in extramedullary hematopoiesis due to beta thalassemia intermedia. Hematology 2008;13:183-6.  Back to cited text no. 64      
65.Moncef B, Hafedh J. Management of spinal cord compression caused by extramedullary hematopoiesis in beta-thalassemia Intern Med 2008;47:1125-8.  Back to cited text no. 65      
66.Goerner M, Gerull S, Schaefer E, Just M, Sure M, Hirnle P. Painful spinal cord compression as a complication of extramedullary hematopoiesis associated with beta-thalassemia intermedia. Strahlenther Onkol 2008;184:224-6.  Back to cited text no. 66      
67.Gupta P, Eshaghi N, Ghole V, Ketkar M, Garcia-Morales F. Presacral extramedullary hematopoiesis: Report of a case and review of the literature. Clin Imaging 2008;32:487- 9.   Back to cited text no. 67      
68.Heimpel H, Dόhrsen U, Hofbauer P, Rigamonti-Wermlinger V, Kreuser ED, Schwarz K, et al. Bulky extramedullary hematopoiesis is not a rare complication of congenital dyserythropoietic anemia. Ann Hematol 2009 in press.  Back to cited text no. 68      
69.Scott IC, Poynton CH. Polycythemia rubra vera and myelofibrosis with spinal cord compression. J Clin Pathol 2008;61:681-3  Back to cited text no. 69      

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Correspondence Address:
Manoj Jain
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5413.57281

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4 Ectopic bone formation and extramedullary hematopoiesis in the thyroid gland: Report of a case and literature review
Akbulut, S. and Yavuz, R. and Akansu, B. and Sogutcu, N. and Arikanoglu, Z. and Basbug, M.
International Surgery. 2011; 96(3): 260-265
[Pubmed]
5 Extramedullary hematopoiesis involving the central nervous system and surrounding structures
Zherebitskiy, V., Morales, C., Del Bigio, M.R.
Human Pathology. 2011; 42(10): 1524-1530
[Pubmed]
6 Extramedullary hematopoiesis involving the central nervous system and surrounding structures
Viktor Zherebitskiy,Carmen Morales,Marc R. Del Bigio
Human Pathology. 2011; 42(10): 1524
[Pubmed] | [DOI]
7 Ectopic Bone Formation and Extramedullary Hematopoiesis in the Thyroid Gland: Report of a Case and Literature Review
Sami Akbulut,Ridvan Yavuz,Bulent Akansu,Nilgun Sogutcu,Zulfu Arikanoglu,Murat Basbug
International Surgery. 2011; 96(3): 260
[Pubmed] | [DOI]



 

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