Title: EXTRAMEDULLARY HEMATOPOIESIS PRESENTING AS PULMONARY NODULES IN A PATIENT WITH RENAL CELL CARCINOMA
Abstract: SESSION TITLE: Fellows Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Extramedullary hematopoiesis (EMH) is red blood cell production occurs outside the bone marrow, often to compensate for hemolytic anemia and myeloproliferative disorders1,2 and some reports in malignant solid tumors such as breast and lung cancers.2,3 We present a case of EMH presenting as pulmonary nodules in a patient with renal cell cancer, which could have been mistaken for metastases. CASE PRESENTATION: 63-year-old female with diabetes and hypertension presenting with several days of worsening abdominal and back pain. She was an intermittent smoker with numerous pets to include 19 parakeets and chickens. Physical exam was unremarkable. Initial laboratory values were unremarkable except for an elevated hemoglobin of 17.6x103/mm3 and a hematocrit of 51.1x103/mm3. CT scan several pulmonary nodules and a large right renal lesion. Renal biopsy confirmed renal cell carcinoma (RCC). Robot navigation biopsy of largest pulmonary nodule in right middle lobe showed this to be extramedullary hematopoiesis and not metastases. DISCUSSION: Though the elevated hemoglobin and hematocrit could have been due to the RCC, she had a pulmonary lesion consistent with EMH. Confirming EMH in the pulmonary nodule prevented inappropriate upstaging of the patient’s RCC. A retrospective literature review was conducted for EMH patients with malignant solid tumors. Breast cancer was the most common (31%). A variety of body sites can have these lesions; lymph nodes (19.0%) and liver (16.7%) were the most common. Though most patients were asymptomatic, treatment modalities include surgery, hydroxyurea, and blood transfusions.4 CONCLUSIONS: Extramedullary hematopoiesis should be considered in the differential diagnosis of pulmonary nodules in patients with extrathoracic malignancy. Reference #1: 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(3):607-609. Reference #2: Vassiliou V, Papamichael D, Lutz S, et al. Presacral Extramedullary Hematopoiesis in a Patient with Rectal Adenocarcinoma: Report of a Case and Literature Review. J Gastrointest Cancer. 2012;43 Suppl 1:S131-135. Reference #3: O'Malley DP. Benign extramedullary myeloid proliferations. Mod Pathol. 2007;20(4):405-415. DISCLOSURES: No relevant relationships by William Kelly, source=Web Response No relevant relationships by Jason Nam, source=Web Response My spouse/partner as a Employee relationship with Medtronic Please note: >$100000 Added 04/18/2020 by Michael Pritchett, source=Web Response, value=Salary Consultant relationship with Medtronic Please note: $5001 - $20000 Added 04/18/2020 by Michael Pritchett, source=Web Response, value=Consulting fee Consultant relationship with Johnson & Johnson Please note: $5001 - $20000 Added 04/18/2020 by Michael Pritchett, source=Web Response, value=Consulting fee Consultant relationship with AstraZeneca Please note: $20001 - $100000 Added 04/18/2020 by Michael Pritchett, source=Web Response, value=Consulting fee Consultant relationship with Intuitive Please note: $20001 - $100000 Added 04/18/2020 by Michael Pritchett, source=Web Response, value=Consulting fee Consultant relationship with BodyVision Please note: $5001 - $20000 Added 04/18/2020 by Michael Pritchett, source=Web Response, value=Consulting fee Consultant relationship with Boston Scientific Please note: $1001 - $5000 Added 04/18/2020 by Michael Pritchett, source=Web Response, value=Consulting fee Research relationship with Philips Please note: $5001 - $20000 Added 04/18/2020 by Michael Pritchett, source=Web Response, value=Grant/Research Support Consultant relationship with Biodesix Please note: $5001 - $20000 Added 04/18/2020 by Michael Pritchett, source=Web Response, value=Consulting fee