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Intracranial extramedullary hematopoiesis associated with pilocytic astrocytoma: a case report

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Intracranial EMH is only occasionally found in primary brain tumors (mostly hemangioblastomas) and, to our knowledge, this is the first case of EMH associated with an astrocytoma. Intracranial extramedullary hematopoiesis (EMH) is described in a 29-year-old man with a recurrent pilocytic astrocytoma in the tectal region. Special stains confirmed the identities of erythroid, myeloid and megakaryocytic cells. The patient had no evidence of a predisposing bone marrow disorder or systemic EMH. Although the presence of multinucleated and blastic cells associated with a low-grade brain neoplasm is unusual, recognition of hematopoietic lineages allows EMH to be readily identified. Another tumor resection after a year of follow-up confirmed the absence of malignant progression in this recurrent astrocytoma. The small number of cases describing intracranial EMH in the absence of systemic hematologic abnormalities are correlated with the findings in this case. The low incidence of intracranial EMH indicates that cells with hematopoietic potential are seldom exposed to a supportive microenvironment within the central nervous system. However, intracranial EMH should be included as a potential, ancillary diagnosis when considering brain lesions. This may be particularly true if medical therapies involving growth factors or stem cells are found to promote hematopoiesis.

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  1. Bienzle D, Kwiecien JM, Parent JM (1995) Extramedullary hematopoiesis in the choroid plexus of five dogs. Vet Pathol 32:437–440

    CAS  Google Scholar 

  2. Block M (1949) Erythropoiesis in the nervous system of the embryonic rat. Blood 4:1156–1167

    Google Scholar 

  3. Brown JA, Gomez-Leon G (1984) Subdural hemorrhage secondary to extramedullary hematopoiesis in postpolycythemic myeloid metaplasia. Neurosurgery 14:588–591

    CAS  Google Scholar 

  4. Buetow PC, Perry JJ (1990) Gd-DTPA enhancement in CNS extramedullary hematopoiesis. Am J Neuro Radiol 11:411

    CAS  Google Scholar 

  5. Burger, PC, Scheithauer BW, Vogel FS (2002) Surgical pathology of the nervous system, 4th edn. Churchill Livingstone, New York, p 418

  6. Cornfield DB, Shipkin P, Alavi A, Becker J, Peyster R (1983) Intracranial myeloid metaplasia: diagnosis by CT and Fe52 scans and treatment by cranial irradiation. Am J Hematol 15:273–278

    CAS  PubMed  Google Scholar 

  7. Cramer F, Kimsey MW. (1952) The cerebellar hemangioblastomas. Review of fifty-three cases with special reference to cerebellar cysts and the association of polycythemia. Arch Neurol Psychiatry 67:237–252

    Google Scholar 

  8. Elgin VE, Connolly ES, Millar WS, Feldstein NA, Dwork AJ (2001) Extramedullary hematopoiesis within a frontoethmoidal encephalocele in a newborn with holoprosencephaly. Pediatr Dev Pathol 4:289–297

    Article  CAS  PubMed  Google Scholar 

  9. Gilmour T (1941) Normal hemopoiesis in intra-uterine and neonatal life. J Pathol Bact 52:25

    Google Scholar 

  10. Greenburg MS (2001) Handbook of neurosurgery. Thieme, New York, p 3

  11. Gregorios JB, Bay JW, Dudley AW Jr (1983) Extramedullary hematopoiesis in a malignant meningioma. Neurosurgery 13:447–451

    CAS  Google Scholar 

  12. Ishwar S, Taniguchi RM, Vogel FS (1971) Multiple supratentorial hemangioblastomas. Case study and ultrastructural characteristics. J Neurosurg 35:396–405

    CAS  PubMed  Google Scholar 

  13. Kandel RA, Pritzker KP, Gordon AS, Bilbao JM (1982) Extramedullary hematopoiesis simulating parasagittal meningioma. Can J Neurol Sci 9:49–51

    CAS  PubMed  Google Scholar 

  14. Khalid M, Chishti N, Bannister CM (1992) Foci of extramedullary haematopoiesis in a cerebellar haemangioblastoma. Br J Neurosurg 6:157–162

    PubMed  Google Scholar 

  15. Kim JY, Lee TJ, Chi JG (1996) Congenital quadrigeminal lipoma with osteocartilagenous element. A case report. J Korean Med Sci 11:537–539

    CAS  PubMed  Google Scholar 

  16. Koch BL, Bisset GSI, Bisset RR, Zimmer MB (1994) Intracranial extramedullary hematopoiesis: MR findings with pathologic correlation. Am J Roentgenol 162:1419–1420

    CAS  Google Scholar 

  17. Kolmer W (1921) Uber eine eigenartige bezichung von wanderzellen zu den choroidealplexus des gehirns der wirbeltiere. Anat Anz 54:S:15–19

    Google Scholar 

  18. Landolfi R, Colosimo C, Jr., De Candia E, Castellana MA, De Cristofaro R, Trodella L, Leone G (1988) Meningeal hematopoiesis causing exophthalmus and hemiparesis in myelofibrosis: effect of radiotherapy. A case report. Cancer 62:2346–2349

    CAS  PubMed  Google Scholar 

  19. Marti HH, Wenger RH, Rivas LA, Straumann U, Digicaylioglu M, Henn V, Yonekawa Y, Bauer C, Gassmann M Erythropoietin gene expression in human, monkey and murine brain. Eur J Neurosci 8:666–676

    CAS  PubMed  Google Scholar 

  20. Maximow A (1909) Untersuchungen uber Blut und Bindegewebe. I. Die fruhesten Entwicklungstadien der Blut and Bindegewebezellen beim Saugetierembryo, bis zum Aufgang der Blutbildung in der Leber. Arch F Mikr Anat 73:444

    Google Scholar 

  21. Nalesnik MA, Martinez AJ, Heros RC (1982) Intracranial lipoma with hematopoietic elements (myelolipoma): report of a case with successful surgical resection. Cancer 50:295–299

    CAS  PubMed  Google Scholar 

  22. Okazaki Y, Kurata Y, Makinodan F, Kidachi F, Yokoyana M, Wako Y, Yamagishi Y, Katsuta O, Takechi M, Tsuchitani M (1996) Spontaneous lesions detected in the common cotton-eared marmosets (Callithrix jacchus). J Vet Med Sci 58:181–190

    CAS  PubMed  Google Scholar 

  23. Rubinstein LJ (1972) Tumors of the central nervous system, Series 2. Armed Forces Institute of Pathology, Washington, DC, p 295

  24. Russell DS, Rubinstein LJ (1989) Pathology of tumors of the nervous system, 5th edn. Williams Wilkins, Baltimore, p 643

  25. Scharrer E (1944) The histology of the meningeal myeloid tissue in the ganoids Amia and Lepiosteus. Anat Rec 88:291–310

    Google Scholar 

  26. Sickler GK, Langford LA (1990) Intracranial tumor-forming papillary endothelial hyperplasia—a case report. Clin Neuropathol 9:125–128

    CAS  PubMed  Google Scholar 

  27. Siren AL, Knerlich F, Poser W, Gleiter CH, Bruck W, Ehrenreich H (2001) Erythropoietin and erythropoietin receptor in human ischemic/hyoxic brain. Acta Neuropathol (Berl) 101:271–276

    Google Scholar 

  28. Slater JP (1966) Extramedullary hematopoiesis in a subdural hematoma. Case report. J Neurosurg 25:211–214

    CAS  PubMed  Google Scholar 

  29. Tweardy DJ, Caracciolo D, Valtieri M, Rovera G (1987) Tumor-derived growth factors that support proliferation and differentiation of normal and leukemic hemopoietic cells. Ann NY Acad Sci 511:30–38

    CAS  PubMed  Google Scholar 

  30. Vitkovic L, Chatham JJ, da Cunha A (1995) Distinct expressions of three cytokines by IL-1- stimulated astrocytes in vitro and in AIDS brain. Brain Behav Immun 9:378–388

    Article  CAS  PubMed  Google Scholar 

  31. Ward HP, Block MH (1971) The natural history of agnogenic myeloid metaplasia (AMM) and a critical evaluation of its relationship with the myeloproliferative syndrome. Medicine (Baltimore) 50:357–420

    Google Scholar 

  32. Wright DE, Wagers AJ, Gulati AP, Johnson FL, Weissman IL (2001) Physiological migration of hematopoietic stem and progenitor cells. Science 294:1933–1936

    Article  CAS  PubMed  Google Scholar 

  33. Zec N, Cera P, Towfighi J (1991) Extramedullary hematopoiesis in cerebellar hemangioblastoma. Neurosurgery 29:34–37

    CAS  PubMed  Google Scholar 

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We would like to thank Leslie Viramontes, HT, and colleagues at the University of Pittsburgh Medical Center Immunohistochemistry Laboratory for their technical assistance with special stains. We thank The Nick Eric Wichman Foundation for financial support.

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Correspondence to Marie E. Beckner.

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Beckner, M.E., Lee, J.Y.K., Schochet, S.S. et al. Intracranial extramedullary hematopoiesis associated with pilocytic astrocytoma: a case report. Acta Neuropathol 106, 584–587 (2003).

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