A 59-year-old man presented with persistent abdominal discomfort 12 months after splenectomy for thrombocytopenia to ameliorate progressive myelofibrosis. Physical examination revealed bilateral loin masses. Computed tomography of the abdomen identified perinephric cuffing by soft tissue nodular masses in the perinephric fat (Figure A). Core needle biopsy of the right perinephric fat revealed haematopoietic cells (Figure B).
Extramedullary haematopoiesis is not uncommon when intramedullary haematopoiesis is impaired.1-3 Common sites include the liver and spleen. It is unusual for extramedullary haematopoiesis to involve the perinephric fat. The role of splenectomy in accelerating the development of extramedullary haematopoiesis in uncommon sites has become increasingly apparent.1
- 1. Gibbins J, Pankhurst T, Murray J, et al. Extramedullary haematopoiesis in the kidney: a case report and review of literature. Clin Lab Haematol 2005; 27: 391-394.
- 2. Gryspeerdt S, Oyen R, Van Hoe L, et al. Extramedullary haematopoiesis encasing the pelvicalyceal system. CT findings. Ann Hematol 1995; 71: 53-56.
- 3. Woodward N, Ancliffe P, Griffiths MH, Cohen S. Renal myelofibrosis: an unusual case of renal impairment. Nephrol Dial Transplant 2000; 15: 257-258.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.