Extramedullary Hematopoiesis in Adrenal Incidentaloma: Case Report of an Atypical Histopathological Finding
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CASE REPORT
Extramedullary Hematopoiesis in Adrenal Incidentaloma: Case Report of an Atypical Histopathological Finding Jorge Montalvo-Hernández 1 & José Alfredo Álvarez-López 2 & Rafael Silva 3 & Rafael Humberto Pérez-Soto 4 Received: 11 July 2020 / Accepted: 29 October 2020 # Association of Surgeons of India 2020
Abstract Adrenal gland extramedullary hematopoiesis is extremely rare, and when present, imaging studies may mimic an incidentaloma suspicious of malignancy. We present a 55-year-old woman without a history of hematologic disorder or neoplasms. There was an incidental finding of a 3.2 × 2.4-cm heterogenous adrenal mass and enhanced by contrast abdominal CT scan. Suspicious of malignancy was established, and laparoscopic left adrenalectomy was performed. Histopathological examination and immunohistochemical staining exhibited myeloid and erythroid precursors, as well as megakaryocyte confirming the diagnosis of extramedullary hematopoiesis in the adrenal gland. Keywords Adrenal incidentaloma . Laparoscopic adrenalectomy . Extramedullary hematopoiesis
Introduction Adrenal incidentaloma (AI) is becoming a more common adrenal disorder as a result of an increased detection in the last decades by the widespread use of abdominal ultrasound, computed tomography (CT), and abdominal magnetic resonance imaging (MRI). Assessments of functional status and malignancy risk are the two main objectives of preoperative workup for these patients. Extramedullary hematopoiesis (EMH) is the production of erythroid and myeloid progenitor cells outside the bone marrow as a compensatory mechanism, and in adults, it is typically seen in the clinical scenario of myeloproliferative neoplasms (leukemia/lymphoma), thalassemia, prolonged
* Jorge Montalvo-Hernández [email protected] José Alfredo Álvarez-López [email protected]
iron deficiency anemia, sickle cell disease, myelofibrosis, or polycythemia [1]. EMH occurs more frequently in the liver and spleen followed by the lymph nodes, lung, breast, small bowel, and thymus. Adrenal EMH is extremely rare, and when present, imaging studies may mimic an incidentaloma suspicious of malignancy.
Case Presentation A 55-year-old woman with a history of primary hypothyroidism and hypertension was seen at the outpatient clinic complaining of chronic diarrhea and a 10-kg weight loss in
2
Clinical Endocrinology, North Central Hospital PEMEX, Calle Campo Matillas 52, San Antonio, Azcapotzalco, 02760 Mexico City, Mexico
3
Deparment of Anatomical Pathology, North Central Hospital PEMEX, Calle Campo Matillas 52, San Antonio, Azcapotzalco, 02760 Mexico City, Mexico
4
Endocrine and Advanced Laparoscopic Surgery Service, Deparment of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Vasco de Quiróga No. 15 Colonia Sección XVI, Tlalpan, 14080 Mexico City, Mexico
Rafael Silva [email protected] Rafael Humberto Pérez-Soto [email protected] 1
Endocrine and Advanced Laparoscopic Surgery Service, Deparment of Surgery, North Central Hospital
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