Extramedullary Hematopoiesis in Adrenal Gland. An Uncommon Cause of Adrenal Incidentaloma in Sickle Cell Disease

Extramedullary hematopiesis (EMH) is a response to insufficient blood cell production by producing of blood elements outside of the marrow cavity. It occurs most often due to hemolytic anemias such as thalasemia, hereditary spherocytosis and sickle cell anemia. It also could be seen in prolonged iron deficiency anemia, myelofibrosis, polycythemia, leukemia and lymphoma[1,2,3] . EMH occurs most commonly in the reticuloendothelial system such as spleen and liver, but it may also be seen in organs, such as bowel, breast, brain, pleura and adrenals[2,4] . In our review of literature we found reports of adrenal gland EMH in patients with betathalasemia, agnogenic myeloid metaplasia and hereditary spherocytosis. EMH in sickle cell anemia has been reported in paranasal sinuses, mediastinum and retroperitoneum. Here we report a case of adrenal gland EMH as adrenal incidentaloma in a patient with sickle cell anemia; in literature review no similar result is found[1-8] .