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The report presents a 58-year-old man who developed pericardial EMH secondary to metastatic gastrointestinal or pancreaticobiliary adenocarcinoma, presenting with recurrent fatigue and shortness of breath. After pleural and pericardial effusions were managed, markedly elevated alkaline phosphatase prompted bone scanning showing diffuse sclerotic lesions, and pericardial fluid analysis demonstrated EMH. Rather than cytokine signaling alone, the proposed mechanism involves extensive disruption of bone marrow hematopoiesis akin to myeloproliferative neoplasms.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/pericardial-extramedullary-hematopoiesis-associated-with-metastatic-adenocarcinoma-of-gastrointestinal-or-pancreaticobiliary-origin-a-case-report/385518/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/pericardial-extramedullary-hematopoiesis-associated-with-metastatic-adenocarcinoma-of-gastrointestinal-or-pancreaticobiliary-origin-a-case-report/385518.png","ImageObject",300,407,{"name":92,"@type":93},"CatatanPagi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What condition links extramedullary hematopoiesis to solid tumors in this case?","Question",{"text":113,"@type":114},"Extramedullary hematopoiesis is described as a rare complication of solid tumor malignancies, with this case focusing on pericardial EMH from metastatic gastrointestinal or pancreaticobiliary adenocarcinoma.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did clinicians evaluate the patient’s recurrent effusions and elevated lab findings?",{"text":118,"@type":114},"The patient was treated with thoracocentesis and pericardiocentesis, and markedly elevated alkaline phosphatase led to a bone scan showing multiple diffuse sclerotic metastatic lesions.",{"name":120,"@type":111,"acceptedAnswer":121},"What diagnostic finding confirmed extramedullary hematopoiesis in the pericardium?",{"text":122,"@type":114},"Cytospin morphology of the pericardial fluid demonstrated EMH, after pleural fluid evaluation diagnosed metastatic adenocarcinoma.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},385518,1790525620,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},962090894170,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Case Reports in Oncology  \n\n| Case Rep Oncol 2023;16:102–107 |  |\n| --- | --- |\n| DOI: 10.1159/000529123\u003Cbr>Received: September 5, 2022\u003Cbr>Accepted: December 19, 2022\u003Cbr>Published online: February 17, 2023 | © 2023 The Author(s) .\u003Cbr>Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) |\n\nThis article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ([http://www.karger.com/Services/OpenAccessLicense](http://www.karger.com/Services/OpenAccessLicense)). Usage and distribution for commercial purposes requires written permission.  \nCase Report  \nPericardial Extramedullary Hematopoiesis Associated with Metastatic Adenocarcinoma of Gastrointestinal or Pancreaticobiliary Origin: A Case Report  \nMaud Ahmad a Benjamin Chin-Yeeb Nikhil Sangle c Kamilia Rizkallac Ian Chin-Yeec Cyrus C. Hsiab  \naSchulich School of Medicine and Dentistry, London, ON, Canada; b Division of Hematology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; c Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada  \nKeywords  \nExtramedullary hematopoiesis · Pericardial fluid · Metastatic carcinoma  \nAbstract  \nExtramedullary hematopoiesis (EMH) is a rare complication of solid tumor malignancies. We describe the first case of a patient who developed EMH in the pericardium secondary to metastatic gastrointestinal or pancreaticobiliary cancer. A 58-year-old man presented with recurrent episodes of fatigue and shortness of breath and was treated with thoracocentesis and pericardiocentesis for pleural and pericardial effusions, respectively. Owing to a markedly elevated alkaline phosphatase, a bone scan was performed and demonstrated diffuse sclerotic lesions. Evaluation of pleural effusion diagnosed metastatic adenocarcinoma, and cytospin morphology of the pericardial fluid demonstrated EMH. While EMH secondary to solid tumors is commonly suggested to be due to cytokine signaling, we propose the mechanism of EMH inthis patient was due to extensive disruption of bone marrow hematopoiesis, similar to what is seen in myeloproliferative neoplasms.  \n© 2023 The Author(s) .  \nPublished by S. KargerAG, Basel  \nCorrespondence to:  \nCyrus C. Hsia, [cyrus.hsia@lhsc.on.ca](cyrus.hsia@lhsc.on.ca)  \nCase Reports in Oncology  \nCase Rep Oncol 2023;16:102–107 103  \n\n| DOI: 10.1159/000529123 | © 2023 The Author(s) . Published by S. Karger AG, Basel [www.karger.com/cro](www.karger.com/cro) |\n| --- | --- |\n\nAhmad et al.: Pericardial Extramedullary Hematopoiesis Secondary to Metastatic Adenocarcinoma  \nIntroduction  \nExtramedullary hematopoiesis (EMH) refers to the formation of blood cellular components outside of the bone marrow [1] . Physiologic EMH occurs in normal fetal development in the yolk sac followed by the liver and spleen [1–3] until the third trimester when the main site of hematopoiesis is the bone marrow and this persists into the remainder of adult life.  \nPathologic EMH may be triggered by stress conditions such as infection or anemia [1, 2] but is most commonly observed in myeloproliferative neoplasms, such as myelofibrosis, polycythemia vera, and chronic myeloid leukemia [4] . In patients with myeloproliferative neoplasms, disrupted bone marrow hematopoiesis can trigger the release of hematopoietic stem cell/progenitor cells into the peripheral blood in a process called mobilization and homing to extramedullary sites [2] . Common sites of EMH include the spleen, liver, lymph nodes, and paravertebral regions [5, 6] . Less common tissues associated with EMH include the heart, fatty tissue, and adrenals. EMH occurs less commonly in cases of malignant solid tumors. When these cases are present, imaging techniques used for staging cancer may misdiagnose EMH as a site of metastasis [7] . We describe a rare case of EMH in the pericardium secondary to metastatic adenocarcinoma o","cbCailKB1HL20W43","https://ap.wps.com/l/cbCailKB1HL20W43","pdf",488341,"English","# Case Report\n## Introduction\n## Case Presentation","[{\"question\":\"What condition links extramedullary hematopoiesis to solid tumors in this case?\",\"answer\":\"Extramedullary hematopoiesis is described as a rare complication of solid tumor malignancies, with this case focusing on pericardial EMH from metastatic gastrointestinal or pancreaticobiliary adenocarcinoma.\"},{\"question\":\"How did clinicians evaluate the patient’s recurrent effusions and elevated lab findings?\",\"answer\":\"The patient was treated with thoracocentesis and pericardiocentesis, and markedly elevated alkaline phosphatase led to a bone scan showing multiple diffuse sclerotic metastatic lesions.\"},{\"question\":\"What diagnostic finding confirmed extramedullary hematopoiesis in the pericardium?\",\"answer\":\"Cytospin morphology of the pericardial fluid demonstrated EMH, after pleural fluid evaluation diagnosed metastatic adenocarcinoma.\"}]","Pericardial Extramedullary Hematopoiesis Associated with Metastatic Adenocarcinoma of Gastrointestinal or Pancreaticobiliary Origin - A Case Report | PDF",1790269757,15]