ANSWER TO KCIAPM CYTOLOGY SLIDE SEMINAR JULY 2014

2. CASE 14

3. • 54 year male
• Complaints of low back pain- 6 mths
• USG: presacral mass
• Guided FNAC was performed

10. DIAGNOSIS

11. • History of repeated blood transfusions:
weakness, fatigue- since 6 years
• CT scan: gross splenomegaly ;
Retroperitoneal sarcoma

13. • BONE MARROW ASPIRATION: hypercellular
marrow (outside)
• BMA (KMIO) : hypocellular aspirate
• BMB : predominantly adipocytes with focus of
marrow fibrosis
• HEMOGLOBIN ELECTROPHORESIS
HbF – 5.70%
HbA – 78.4%
HbA2 – 2.20%
Others

14. Cell Block Study

16. Response
• Malignant carcinoma
• Chordoma
• Malignant tumour

17. EXTRAMEDULLARY
HEMATOPOIESIS

18. EXTRAMEDULLARY HEMATOPOIESIS
• DEFINITION: Hematopoiesis occurring in
organs outside of the bone marrow.
• It occurs in diverse conditions, including fetal
development, normal immune responses, and
pathological circumstances.( HEMATOLOGICAL
AND NON HEMATOLOGICAL )

19. Compensatory process
• Occur whenever and wherever a stem cell
niche/microenvironment is present in a tissue
• Sites: adults are most commonly liver, spleen,
and lymph nodes.
• Rarely, central nervous system.

20. Theories
• Compensatory phenomenon with increased
numbers of circulating hematopoietic stem
cells.(marrow failure)
• Myelostimulatory theory, which proposes that
EMH presents in fetal hematopoietic sites
under stimulation of unknown
myelostimulatory factors
• “Redirected differentiation theory.”
• Presumed bone marrow embolism

21. • Choreography of stromal, humoral and stem
cell interactions is a 3-dimensional interplay
that relies on much more than physical space.
• Although trilineage; 1 or 2 cell types may
predominate.

22. • “Extramedullary hematopoiesis” refers to a
broad range of hematopoietic activities from
the early stages of lineage commitment to late
stages of hematopoietic cell maturation.
• Does not fully supplant the marrow
hematopoiesis, but imperative for the
maturation of hematopoietic cells.