Background: We report a case series of extramedullary hematopoiesis (EMH) diagnosed from the fine needle aspiration (FNA) procedure. Unanticipated EMH is a markedly rare diagnosis that typically presents as a solitary mass of undetermined significance. As such, knowledge of cytopathologic characteristics as well as clinical and radiologic correlates of EMH is paramount. Method and Material: A total of 16 EMH cytopathologic cases were seen at the Johns Hopkins Hospital in the past 22 years. Results: Median age at diagnosis was 61 years and there was no gender bias (male-to-female ratio: 1:1). Presenting signs and symptoms varied widely, from incidental radiographic findings to hemiparesis. Likewise, presumptive clinical diagnoses in 11 of the 16 cases were benign and the other 5 were considered malignant prior to the diagnostic FNA. The most common anatomic site for EMH was the liver, followed by the presacral soft tissue and pleura. While most EMH nodules were singular, a few presented with as many as three radiographically distinct nodules. The average EMH nodule measured 2.8 cm; the EMH liver nodules were larger and measured 4.3 cm on average (p = 0.0043). Conclusion: We share here the salient clinical and radiologic findings and the diagnostic cytopathologic features of EMH in an effort to familiarize the pathologist/cytotechnologist community with this fascinating albeit rare entity.

Babazadeh S, Broadhead ML, Slavin JL, Choong PF: An interesting diagnosis for a presacral mass: case report. Int Semin Surg Oncol 2009;6:18.
Policarpio-Nicolas ML, Bregman SG, Ihsan M, Atkins KA: Mass-forming extramedullary hematopoiesis diagnosed by fine-needle aspiration cytology. Diagn Cytopathol 2006;34:807-811.
Koch CA, Li CY, Mesa RA, Tefferi A: Nonhepatosplenic extramedullary hematopoiesis: associated diseases, pathology, clinical course, and treatment. Mayo Clin Proc 2003;78:1223-1233.
Carazo ER, Herrera RO, de Fuentes TM, Rull JP, Munoz CM: Presacral extramedullary haematopoiesis with involvement of the sciatic nerve. Eur Radiol 1999;9:1404-1406.
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;32:487-489.
Sauer B, Buy X, Gangi A, Roy C: Exceptional localization of extramedullary hematopoiesis: presacral and periureteral masses. Acta Radiol 2007;48:246-248.
Walker AN, Feldman PS, Walker GK: Fine needle aspiration of thoracic extramedullary hematopoiesis. Acta Cytol 1983;27:170-172.
Hanford RB, Schneider GF, MacCarthy JD: Massive thoracic extramedullary hemopoiesis. N Engl J Med 1960;263:120-123.
Malamos B, Papavasiliou C, Avramidis A: Tumour-simulating intrathoracic extramedullary hemopoiesis. Report of a case. Acta Radiol 1962;57:227-231.
Da Costa JL, Loh YS, Hanam E: Extramedullary hemopoiesis with multiple tumor-simulating mediastinal masses in hemoglobin E-thalassemia disease. Chest 1974;65:210-212.
Kumar P, Sotoodeh M, Beddayat GR: Aspiration findings of extramedullary hematopoiesis presenting as an epidural mass. Acta Cytol 1991;35:146-147.
Raab SS, Silverman JF, McLeod DL, Geisinger KR: Fine-needle aspiration cytology of extramedullary hematopoiesis (myeloid metaplasia). Diagn Cytopathol 1993;9:522-526.
Luban NL, Kapur S, DePalma L: Pericardial extramedullary hematopoiesis in a neonate with congenital heart disease. A case report. Acta Cytol 1993;37:729-731.
Lazzi S, Als C, Mazzucchelli L, Kraft R, Kappeler A, Laissue J: Extensive extramedullary hematopoiesis in a thyroid nodule. Mod Pathol 1996;9:1062-1065.
Lemos LB, Baliga M, Benghuzzi HA, Cason Z: Nodular hematopoiesis of the liver diagnosed by fine-needle aspiration cytology. Diagn Cytopathol 1997;16:51-54.
Jan YJ, Chen JT, Chang MC, Ho WL: Fine-needle aspiration cytology of retroperitoneal extramedullary hematopoiesis: a case report. Kaohsiung J Med Sci 1998;14:659-663.
Fassina A, Fedeli U, Borsato S: Extramedullary hematopoiesis of the thyroid gland diagnosed by FNA cytology. A case report. Acta Cytol 1999;43:1181-1183.
Mastalerz L, Grzanka P, Zarychta J, Orlowska-Heitzman J: Extramedullary hemopoiesis presenting as a tumor of the posterior mediastinum in a patient with hemolytic anemia. Pol Arch Med Wewn 1999;101:333-336.
Kumar PV, Arasteh M, Musallaye A, Hakshanash M: Fine needle aspiration diagnosis of extramedullary hematopoiesis presenting as a right lung mass. Acta Cytol 2000;44:698-699.
Orucevic A, Reddy VB, Selvaggi SM, Green L, Spitz DJ, Gattuso P: Fine-needle aspiration of extranodal and extramedullary hematopoietic malignancies. Diagn Cytopathol 2000;23:318-321.
Xiros N, Economopoulos T, Papageorgiou E, Mantzios G, Raptis S: Massive hemothorax due to intrathoracic extramedullary hematopoiesis in a patient with hereditary spherocytosis. Ann Hematol 2001;80:38-40.
Du E, Overstreet K, Zhou W, Baird G, Baird S, Bouvet M, Haghighi P: Fine needle aspiration of splenic extramedullary hematopoiesis presenting as a solitary mass. A case report. Acta Cytol 2002;46:1138-1142.
Tamiolakis D, P PT, Simopoulos C, Kotini A, Venizelos J, Alexiadis G, Manavis J, Papadopoulos N: Renal extramedullary hematopoietic tumor diagnosed by fine needle aspiration: a case report. Acta Clin Belg 2003;58:299-301.
Al-Marzooq YM, Al-Bahrani AT, Chopra R, Al-Momatten MI: Fine-needle aspiration biopsy diagnosis of intrathoracic extramedullary hematopoiesis presenting as a posterior mediastinal tumor in a patient with sickle-cell disease: case report. Diagn Cytopathol 2004;30:119-121.
Saenz-Santamaria J, Catalina-Fernandez I: Fine needle aspiration diagnosis of extramedullary hematopoiesis resembling mediastinal and paravesical tumors. A report of 2 cases. Acta Cytol 2004;48:95-98.
Tamiolakis D, Venizelos J, Prassopoulos P, Simopoulos S, Bolioti S, Tsiapali M, Papadopoulos N: Intrahepatic extramedullary hematopoietic tumor mimicking metastatic carcinoma from a colonic primary. Onkologie 2004;27:65-67.
Goldman BI, Wurzel J: Hematopoiesis/erythropoiesis in myocardial infarcts. Mod Pathol 2001;14:589-594.
Al-Aabassi A, Murad BA: Presacral extramedullary hematopoiesis: a diagnostic confusion concerning a rare presentation. Med Princ Pract 2005;14:358-362.
Youngster I, Weiss M, Drobot A, Eitan A: An unusual presacral mass: extramedullary hematopoiesis. J Gastrointest Surg 2006;10:927-929.
Ward HP, Block MH: The natural history of agnogenic myeloid metaplasia (AMM) and a critical evaluation of its relationship with the myeloproliferative syndrome. Medicine (Baltimore) 1971;50:357-420.
Wolf BC, Neiman RS: Hypothesis: splenic filtration and the pathogenesis of extramedullary hematopoiesis in agnogenic myeloid metaplasia. Hematol Pathol 1987;1:77-80.
O'Keane JC, Wolf BC, Neiman RS: The pathogenesis of splenic extramedullary hematopoiesis in metastatic carcinoma. Cancer 1989;63:1539-1543.
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