Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2022; 10(19): 6626-6635
Published online Jul 6, 2022. doi: 10.12998/wjcc.v10.i19.6626
Magnetic resonance imaging features of intrahepatic extramedullary hematopoiesis: Three case reports
Ma Luo, Jia-Wen Chen, Chuan-Miao Xie
Ma Luo, Jia-Wen Chen, Chuan-Miao Xie, Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China
Chuan-Miao Xie, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China
Chuan-Miao Xie, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, Guangdong Province, China
Author contributions: Luo M and Chen JW collected the data; Luo M, Chen JW and Xie CM analyzed the data; Luo M wrote the original draft; Xie CM reviewed and edited the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Chuan-Miao Xie, MD, Chief Doctor, Professor, Department of Radiology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou 510060, Guangdong Province, China. xchuanm@sysucc.org.cn
Received: December 12, 2021
Peer-review started: December 12, 2021
First decision: January 26, 2022
Revised: February 18, 2022
Accepted: May 16, 2022
Article in press: May 16, 2022
Published online: July 6, 2022
Processing time: 194 Days and 2.9 Hours
Abstract
BACKGROUND

Extramedullary hematopoiesis rarely occurs within the liver alone, and is easily misdiagnosed. The radiological literature on this disease is exclusively case reports. There is a paucity of literature on the role of magnetic resonance imaging (MRI). The most common imaging modalities used are computed tomography and ultrasound. This report aims to provide more data on the appearance of extramedullary hematopoiesis using MRI to help radiologists establish the diagnosis.

CASE SUMMARY

Three patients (one male and two females) were incidentally found to have a hepatic mass or nodule, without hepatomegaly or splenomegaly. Laboratory tests including liver function, serum hepatic tumor markers, and hepatitis serologic markers were normal. On MRI scans, all lesions showed lower signal intensity on in-phase images than on out-phase images. One case showed changes in signal intensity on T2 weighted images (WI) and diffusion WI, which shifted from hyperintensity to hypointensity with size enlargement between two rounds of imaging examination. These lesions exhibited different enhancement patterns on dynamic contrast enhancement series.

CONCLUSION

The MRI signal change and in-/out-phase image might provide useful information and help radiologists establish the diagnosis of intrahepatic extramedullary hematopoiesis.

Keywords: Liver; Extramedullary hematopoiesis; Signal intensity; Magnetic resonance imaging; Case report

Core Tip: The magnetic resonance imaging signal change, including the signal change on T2 weighted image (WI) and diffusion WI, and the in-/out-phase image might provide useful information and help radiologists establish the diagnosis of extramedullary hematopoiesis. Intrahepatic extramedullary hematopoiesis (IEMH) may exhibit different patterns of enhancement, depending on different stages of the disease. IEMH can also be seen in patients without evidence of hematological disease.