Extrameduallary hematopoesis of the endometrium in a successfully treated case with acute myeloid leukemia

Dear Editor, We have recently received an endometrial biopsy of a 51-year-old lady complaining of postmenopausal bleeding. The patient was diagnosed, six years ago, with acute myeloid leukemia. She was successfully treated and, currently, is in remission for the last four years. The endometrial specimen showed features of chronic non-specific endometritis, with the presence of mixed-pattern glands that were inactive looking to others with secretory changes. The stroma had focal areas of inflammatory cells, comprising plasma cells. In some places, megakaryocytes and nucleated RBCs were also noted [Figure 1], featuring extra-medullary hematopoiesis (EMH).Figure 1: Megakaryocytes (arrows, a) and nucleated RBCs (arrows, b) present within the endometrial stroma having areas of oedema. Part of endometrial gland is present in the upper right corner (H&E 200x)Extra-medullary hematopoiesis represents abnormal development and growth of hematopoietic tissue outside the bone marrow.[1] EMH of the endometrium is a rare finding that might be associated with hematological disorders in about half of the cases.[1,2] These include myelofibrosis, chronic myeloproliferative disorders hematologic malignancies, or even anemia.[2-4] This diagnosis might require a thorough examination of the patients to exclude the possible association of such a serious disease.[3,5] However, other options prefer to ignore further diagnostic workups.[1,3] Careful examination of endometrial curettings or pipelle samplings performed for abnormal uterine bleeding is always warranted to exclude endometrial malignancies or prenoplastic conditions.[4] Moreover, the pathologist should exclude abnormalities in any associated non-endometrial tissues. The most common situation is to exclude cervical pathologies.[6] Herein, we would like to enhance the attention of our pathology colleagues to examine the benign endometrial specimen in balance with all the clinical settings of the patients. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.