Extramedullary haematopoiesis presenting as an adnexal mass in a patient with β-thalassaemia

Abstract

Solid masses of the ovaries raise the suspicion of malignancy or metastasis and require histological diagnosis. Extramedullary haematopoesis (EMH) is a rare histological finding of a mass of the adnexa. The sonographic pattern of EMH has rarely been described in the literature. Transvaginal biopsy of EMH has not been reported in the literature. We present a case of adnexal EMH in a patient affected with β-thalassaemia, and we performed a narrative review. Only in our case, the sonographic pattern was described, and a transvaginal ultrasound-guided core biopsy was used. Assessing patients' medical history and correlating it to the findings of diagnostic imaging is of paramount importance when evaluating patients with adnexal masses. The correct interpretation of sonographic images can avoid unnecessarily invasive procedures. A transvaginal biopsy could be a safe, easy and well-tolerated method to gain definite histological diagnosis in cases where a primary ovarian malignancy is not suspected.

Keywords: Haematology (drugs and medicines); Obstetrics, gynaecology and fertility; Radiology; Ultrasonography.

Figure 1

(A) 2D grey scale ultrasound image of the solid lesion of the right adnexa. (B) 2D colour ultrasound image of the solid lesion of the right adnexa with acoustic shadows. (C) 2D colour doppler ultrasound image of the solid lesion of the right adnexa with moderate blood flow (colour score 3). (D) Ultrasound image of the solid lesion attached to the left ovary with the same features.

Figure 2

The histological specimen (H&E): extramedullary haematopoiesis with predominance of erythropoiesis ((A, B) dark, round cells), single megakaryocytes ((A, B) black arrows) and eosinophils ((B) white arrows) in the biopsy specimen of the adnexal mass in our patient with β-thalassaemia intermedia.