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November 1988

Extramedullary Hematopoiesis Occurring in a Hemangioma of the Skin

Author Affiliations

Department of Pathology Veterans Administration Medical Center 2002 Holcombe Blvd Houston, TX 77030

Arch Dermatol. 1988;124(11):1720-1721. doi:10.1001/archderm.1988.01670110076021

To the Editor.—  Extramedullary hematopoiesis (EMH) rarely involves the skin. It occurs more commonly in the spleen, liver, kidneys, and lymph nodes. We recently observed a patient with myelofibrosis who had a skin lesion that, by histologic examination, was a hemangioma with extramedullary hematopoiesis.

Report of a Case.—  A 53-year-old man was admitted to the Veterans Administration Hospital, Houston, with syncope and weakness. He had a 12-year history of Philadelphia chromosomenegative agnogenic myeloid metaplasia (AMM). In the last three years, he experienced gradually increasing white blood cell counts of 10.0 to 50.0 × 109/L, which responded to therapy with busulfan (Myleran) and hydroxyurea. He also developed transfusion-dependent chronic anemia and thrombocytopenia, which was treated by splenectomy. His spleen weighed 4300 g and had prominent EMH. Three weeks after the splenectomy, an 8-mm, raised, blue, nodular skin lesion developed on the anterior aspect of the patient's chest that was