Intracranial extramedullary hematopoiesis masquerading as progressive metastasis in a child with stage 4 neuroblastoma: Utility of sulfur colloid scan

Abstract

Extramedullary hematopoiesis is production of blood cells outside bone marrow which occurs in a variety of disorders including myelofibrosis. We present a 15 month old child with stage 4 neuroblastoma with secondary myelofibrosis which resulted in intracranial extramedullary hematopoiesis, posing a diagnostic and therapeutic dilemma. This was resolved with a sulfur colloid isotope scan which confirmed extramedullary hematopoiesis and not a progressing metastasis. This helped us continue therapy with curative intent. To the best of our knowledge we did not come across any report of neuroblastoma with myelofibrosis and intracranial extramedullary hematopoiesis mimicking progression of metastasis.

Keywords

• Extramedullary hematopoiesis
• Neuroblastoma
• Sulfur colloid scan
• Metastasis