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Splenic Extramedullary Hematopoiesis in a Patient Receiving Intermittently Administered Granulocyte ColonyStimulating Factor

Patrick P. Litam, MD; Henry D. Friedman, MD; and Thomas P. Loughran Jr., MD
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From the Veterans Administration Medical Center and the State University of New York Health Science Center, Syracuse, New York. Requests for Reprints: Patrick P. Litam, MD, Department of Medicine, State University of New York Health Science Center, 750 East Adams Street, Syracuse, NY 13210. Grant Support: In part by grants CA 46903 and CA 54552 from the National Cancer Institute, National Institutes of Health, Bethesda, Maryland.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;118(12):954-955. doi:10.7326/0003-4819-118-12-199306150-00007
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A 22-year-old man received four cycles of cyclophosphamide, vincristine, doxorubicin, prednisone, and etoposide with intermittent granulocyte colonystimulating factor (G-CSF) for the treatment of a high-grade, stage I malignant lymphoma involving the axilla. On re-evaluation, the axillary mass had completely disappeared; however, splenomegaly was present and lactate dehydrogenase levels were elevated 3 weeks after his final chemotherapy and G-CSF treatments. Because refractory disease was a concern, splenectomy was done. Spleen sections showed extramedullary hematopoiesis but no lymphomatous involvement. To our knowledge, we report the first case of splenomegaly with extramedullary hematopoiesis in a patient receiving intermittent G-CSF therapy. Clinicians should be aware that splenomegaly occurring in this setting does not necessarily indicate refractory lymphoma.


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Figure 1.
Spleen section showing extramedullary hematopoiesis.arrow

In this particular field, both a megakaryocyte ( ) and erythroid precursors (small cells with dense round nuclei located near the e) are present. (Hematoxylin and eosin; original magnification, 290).

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