Extramedullary hematopoiesis secondary to malignant solid tumors: a case report and literature review.
Extramedullary hematopoiesis secondary to malignant solid tumors: a case report and literature review.
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DOI：
10.2147/cmar.s161746
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发表时间：
2018
影响因子：
3.3
通讯作者：
Wang L
中科院分区：
文献类型：
--
作者：
Bao Y;Liu Z;Guo M;Li B;Sun X;Wang L
髓外造血（EMH）通常发生在血液系统疾病中，但在恶性实体瘤中更罕见。由于EMH在CT和MRI上表现不典型，易被误诊为肿瘤转移，导致TNM分期不正确，治疗不当。在此，我们报告了第一例胸膜EMH发生在食管癌患者的胸膜病变首次被诊断为转移，并证实EMH后，针吸活检。此外，通过分析PubMed和Medline数据库中患有恶性实体瘤的EMH患者进行了回顾性审查。共入组42例EMH实体瘤患者，乳腺癌最常见（n=13，31.0%），其次为肾癌（n=7，16.7%）和肺癌（n=6，14.3%）。恶性实体瘤患者的EMH可累及多种身体部位，其中淋巴结（n=8，19.0%）和肝脏（n=7，16.7%）最常见，其次是肾脏（n=6，14.3%）。所有患者均经手术切除、活检或尸检确诊为EMH。EMH的治疗策略包括手术（n=25，59.5%）、羟基脲（n=1，2.4%）和输血（n=2，4.8%）;另有14例患者（33.3%）接受了临床观察，未进行干预。在报告结局的患者中，10例患者（23.8%）保持良好的体能状态，另有6例患者死于恶性肿瘤。本研究首次总结了EMH在恶性实体瘤中的表现，为临床实践提供了有益的指导，尤其是对抗肿瘤治疗过程中出现无反应病灶的患者的治疗。
Extramedullary hematopoiesis (EMH) usually occurs in hematological disease, but more rarely develops in cases of malignant solid tumors. Due to its features on computed tomography (CT) and magnetic resonance imaging (MRI) that are atypical, EMH in tumor patients might easily be misdiagnosed as metastasis leading to the improper TNM staging and inappropriate therapy. Here, we reported the first case of pleural EMH occurring in a patient with esophageal carcinoma whose pleural lesion was first diagnosed as metastasis and confirmed EMH after the needle biopsy. In addition, a retrospective review was conducted by analyzing patients presented with EMH with malignant solid tumors from PubMed and Medline databases. A total of 42 solid tumor patients with EMH were enrolled, and breast cancer was the most common (n=13, 31.0%), followed by renal carcinoma (n=7, 16.7%) and lung cancer (n=6, 14.3%). A wide variety of body sites may be affected by EMH in malignant solid tumor patients, of which the lymph nodes (n=8, 19.0%) and liver (n=7, 16.7%) were the most common, followed by the kidney (n=6, 14.3%). All patients were diagnosed with EMH by excision, biopsy, or autopsy. Treatment strategies for EMH included surgery (n=25, 59.5%), hydroxyurea (n=1, 2.4%), and blood transfusions (n=2, 4.8%); a further 14 patients (33.3%) were subjected to clinical observation without intervention. Of the patients for whom outcome was reported, 10 patients maintained a good performance status (23.8%) and a further six patients died from the malignant tumor. This was the first study to summarize the presentations of EMH in malignant solid tumors, and our findings might provide some useful guidance for clinical practice, especially for treating patients harboring nonresponse lesions during the antitumor treatment.