Revista de informes de casos clínicos

Extramedullary Hematopoiesis: Uncommon Case of Giant Adrenal Incidentaloma Mimicking Tumor Mass

Abstract

ELaouni Soukaina*, Jebli Salma, Sassi Samia, Jahid Ahmed, Zouidia Fouad, Elkhanoussi Basma, Bernoussi Zakia and Znati Kaoutar

Extramedullary Hematopoiesis (EMH) is a compensatory phenomenon to insufficient bone marrow function to maintain the circulatory demands. EMH occurs most commonly in the reticuloendothelial system such as spleen, Liver and lymph nodes, or in para osseous sites. EMH in the adrenal is rare with fewer than 10 cases reported, presenting as a giant adrenal mass are extremely rare. We report 38-year-old women with history of β-thalassemia since childhood. Computed Tomography (CT) was revealed a giant right adrenal mass with heterogeneous density mimicking a tumor mass with moderate splenomegaly associated, after excluding hormonal secretion. Ultrasound-guided biopsy was performed and reported fibrocollagenous tissue displaying trilineage haematopoiesis in favor of adrenal EMH, thus malignancy is eliminated. As a giant mass, treatment was an excision surgery associated with iterative transfusions to prevent recurrence. In daily practice, practitioners should pay attention to the differential diagnosis in any patients with chronic hematologic disorders suggestive for EMH even of uncommon location. A confirmatory preoperative biopsy is recommended to avoid unnecessary procedure.