We report a case of extramedullary hematopoiesis (EMH) in uterine leiomyoma and associated numerous intravascular thrombi. A 29-year-old nulliparous female presented with heavy vaginal bleeding and a hematocrit of 22%. No bone marrow biopsy has been performed. She had a history of uterine leiomyomata and menorrhagia for a year. A transvaginal ultrasound confirmed the presence of a uterine leiomyoma. The patient was treated conservatively with oral contraceptive pills due to desire for fertility. However, she continued to have heavy vaginal bleeding and developed bilateral upper extremity deep vein thrombosis and multiple superficial vein thromboses after two months. An exploratory laparotomy with uterine myomectomy was performed. Gross examination of the specimen revealed a single nodular mass measuring ？cm with a white-tan swirling cut surface. Microscopic examination revealed benign smooth muscle consistent with leiomyoma and numerous intravascular thrombi both with areas of EMH. Immunohistochemical stains confirmed the presence of all three benign lineages of hematopoietic cells. Occurrence of EMH in uterine leiomyoma and intravascular thrombi is very rare. It may be related to systemic hematopoietic stimulation due to severe chronic anemia and local presence of hematopoietic growth factors and/or cytokines. 1. Introduction Extramedullary hematopoiesis (EMH) refers to hematopoiesis outside the bone marrow. It is usually seen in association with hematological diseases. Some common ones include thalassemia, hereditary spherocytosis, sickle cell anemia, congenital dyserythroblastic anemia, and immune thrombocytopenic purpura [1, 2]. Liver, spleen, and lymph nodes are frequently involved [1]. Although uncommon, involvement of other organs or sites, as well as association with nonhematopoietic neoplasms, has also been reported [1, 2]. Tumors reported to be associated with EMH include hemangioma, cerebellar hemangioblastoma, hepatoblastomas, pilomatricoma, hepatic angiosarcoma, endometrial carcinoma, meningioma, hepatic adenoma, spindle cell lipoma, liposarcoma, myofibroblastic tumor, and renal tumors [2]. EMH in uterine leiomyoma and thrombi is very rare. Here we report a case of EMH that is simultaneously present in the stroma of uterine leiomyoma and in the intravascular thrombi within the uterine leiomyoma. 2. Case Presentation A 29-year-old nulliparous female came to the emergency department with heavy vaginal bleeding, hematocrit of 22% (normal range 33–45%), RBC (normal range , WBC (normal range ), hemoglobin 6.8？g/dL (normal range 11.3–15.2？g/dL),
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