Extramedullary hematopoeisis within a convexity meningioma.
BACKGROUND
Hematopoiesis outside the bone marrow is known to occur in patients with severe anemia, leukemia, polycythemia, or myelofibrosis, and in patients affected by chronic poisoning by marrow-toxic substances.


METHODS
A 66-year-old right-handed man complained of 4 days of terrible right-sided, sharp, and shooting headache for which he saw his primary care provider. Routine laboratory examination showed a WBC count of 30800/microL. Neuroimaging showed a large, right frontotemporal, extra-axial, heterogeneously enhancing, dural based mass with associated recent intramural hemorrhage with evidence of midline shift and uncal herniation. The mass was resected using a right-sided extended craniotomy with anterior fossa and middle fossa approach. A hematoxylin-eosin-stained biopsy specimen showed whorls of tumor cells, diagnostic of a meningioma. Interspersed within the tumor bulk were nucleated RBCs, representing areas of extramedullary erythropoiesis within a meningioma. Flow cytometric evaluation confirmed the clinical suspicion of an underlying chronic lymphocytic leukemia.


CONCLUSIONS
Occurrence of extramedullary hematopoiesis within a meningioma is extremely rare. Various theories may explain the occurrence of extramedullary hematopoiesis occurring within a meningioma in our patient, such as hematopoietic differentiation of multipotent mesenchymal tumor cells; direct extension of hematopoietic activity from the neighboring marrow cavity; displacement from bone marrow of stem cells that settle and develop in tissues where capillaries and blood vessels proliferate, such as a meningioma; or congenital heterotopia of totipotent connective tissue cells, which, under certain circumstances, may transform into hematopoietic tissue.
Mathews
Marlon S
MS
Department of Neurosurgery, University of California, Irvine, Orange, CA 92804, USA. mmathews@uci.edu
Duma
Christopher M
CM
Brant-Zawadzki
Michael
M
Hasso
Anton
A
Westhout
Franklin D
FD
Klein
David J
DJ
Vanhorn
Denise
D
D000368:Aged; D006411:Hematopoiesis, Extramedullary; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D008579:Meningioma / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery