EXTRAMEDULLARY HEMATOPOIESIS IN UTERINE LEIOMYOMA Erson Aksu 1

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EXTRAMEDULLARY HEMATOPOIESIS IN UTERINE LEIOMYOMA Erson Aksu 1, Ayşe Gül Kayalı 1, Meltem Öznur

EXTRAMEDULLARY HEMATOPOIESIS IN UTERINE LEIOMYOMA Erson Aksu 1, Ayşe Gül Kayalı 1, Meltem Öznur 2, Didem Akkuş 3, Ufuk Göker Taşdemir 4, Ruhiye Ceren Avcı 1, Nicel Taşdemir 1 1 Namık Kemal Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Ana Bilim Dalı, Tekirdağ 2 Namık Kemal Üniversitesi Tıp Fakültesi Patoloji Ana Bilim Dalı, Tekirdağ 3 Sağlık bakanlığı siirt devlet hastanesi Kadın Hastalıkları ve Doğum, Siirt 4 Sağlık Bakanlığı Tekirdağ Devlet Hastanesi Kadın Hastalıkları ve Doğum, Tekirdağ

INTRODUCTION • Uterine leiomyomas, also known as fibroids or myomas are benign monoclonal tumors

INTRODUCTION • Uterine leiomyomas, also known as fibroids or myomas are benign monoclonal tumors arising from the smooth muscle cells of the myometrium and they are the most common pelvic tumors in women • • Baird DD, Dunson DB, Hill MC, et al. High cumulative insidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188: 100. Serden SP, Brooks PG. Treatment of abnormal uterine bleeding with gynecologic resectoscope. J Reprod Med 1991; 36: 697.

 • EMH is the presence of hemopoietic precursors outside the bone marrow and

• EMH is the presence of hemopoietic precursors outside the bone marrow and peripheral blood. • Myeloproliferative disorders and congenital hematological diseases, such as thalassemia, hereditary spherocytosis and sickle cell disease are relatively frequently encountered in cases.

 • EMH is most commonly (95%) seen in reticuloendothelial organs such as the

• EMH is most commonly (95%) seen in reticuloendothelial organs such as the spleen, liver, and lymph nodes but it has been encountered less frequently in a variety of unusual sites, including the lungs, skin, gallbladder, prostate, kidney, synovium, epididymis, pleura, serous membranes, peritoneum, central nervous system and the uterus • • Humphrey PA, Vollmer RT. Extramedullary hematopoiesis in the prostate. Am J Surg Pathol 1991; 15: 486– 90 Koch CA, Li CY, Mesa RA, Tefferi A. Nonhepatosplenic extramed ullary hematopoiesis: associated diseases, pathology, clinical course, and treatment. Mayo Clin Proc 2003; 78: 1223 33. Valeri RM, Ibrahim N, Sheaff MT. Extramedullary hematopoiesis in the endometrium. Int J Gynecol Pathol 2002; 21: 178 81 Sirgi KE, Swanson PE, Gersell DJ. Extramedullary hematopoiesis in the endometrium. Report of four cases and review of the literature. Am J Clin Pathol 1994; 101: 643 6

 • EMH can be often seen as a compensatory reaction to an underlying

• EMH can be often seen as a compensatory reaction to an underlying hematologic abnormality but it can be occur rarely in hematologically normal individuals • 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 9.

CASE REPORT • A 66 year old man who had been in menopause for

CASE REPORT • A 66 year old man who had been in menopause for 10 years applied to our clinic with 20 days of vaginal bleeding. • A transvaginal ultrasound confirmed a 3*2 cm mass consistent with leiomyoma or poliposis in uterine cavity with an 30 year old intrauterine device without strings.

 • She had undergone hysteroscopic removal of a 30 year old intrauterin device

• She had undergone hysteroscopic removal of a 30 year old intrauterin device and myomectomy because of a degenerated pedunculated submucosal uterine leiomyoma about 3*2, 5*0, 8 cm in size Macroscopic examination (3*2, 5*0, 8 cm)

 • Histological examination showed a calcifia leiomyoma with degenerative changes and EMH. •

• Histological examination showed a calcifia leiomyoma with degenerative changes and EMH. • The patient had no known history of a hematological disorder or systemic disease and also there was no evidence of any such abnormality after detailed hematological work up except she had an intrauterin device for 30 years old.

 • EMH in patients without haematological disorders is very rare. • With immunohistochemical

• EMH in patients without haematological disorders is very rare. • With immunohistochemical studies, several antibodies were used to highlight and confirm the specific cell type of differentiation. • Glycophorin, myeloperoxidase and smooth muscle actine were positive.

 • The laboratory findings of the patient’s blood are reported in Table The

• The laboratory findings of the patient’s blood are reported in Table The laboratory findings

DISCUSSION • Our case is the first case of endometrial EMH described in association

DISCUSSION • Our case is the first case of endometrial EMH described in association with intrauterin device. • The previous reports of endometrial EMH cases are associated with hematological disorders*, retained products of conception**, EMH in uterine leiomyoma associated with thrombi*** • • • *Ward HP, Block MH. The natural history of anogenic myeloid meta plasia (AMM) and a critical evaluation of its relationship with the myeloproliferative syndrome. Medicine 1971; 50; 357 420. **Rosalia M. Valeri, M. D. , Nada Ibrahim, M. B. , and Michael T. Sheaff, M. R. C. Path. Extramedullary Hematopoiesis in the Endometrium. International Journal of Gynecological Pathology 21: 178– 181 ***Xiaoyan Cui, Deniz Peker, Heather O. Greer, Michael G. Conner and Lea Novak. Extramedullary hematopoiesis in uterine leiomyoma associated with numerous intravascular thrombi. Case Rep Pathol. 2014; 2014: 957395

 • Inflammation with numerous cytokines and growth factors may stimulate primitive hematopoietic stem

• Inflammation with numerous cytokines and growth factors may stimulate primitive hematopoietic stem cells. • In conclusion very rare clinical condition like endometrial EMH with an intrauterin device is currently no consensus regarding the pathogenesis and clinical management of this uncommon pathology.

 • Further case reports on this topic are needed. It may help us

• Further case reports on this topic are needed. It may help us to further understand the pathogenesis of EMH with old intrauterin device.

Thank You

Thank You