Multiple esophageal variceal ruptures with massive ascites due to myelofibrosis-induced portal hypertension

Figure 1 Spleen enlargement and dilatation of the splenic vein on abdominal computed tomography.

Figure 2 Microscopic findings on autopsy on bone marrow biopsy. A: Hematoxylin and eosion, × 20; B: Hematoxylin and eosion, × 40; C: Silver, × 40. Adipocyte disappearance and markedly decreased hematopoietic cells.

Figure 3 Endoscopic image in the lower esophagus. A: Showing a hematocystic spot by the white arrow; B: Endoscopic variceal ligation was thus conducted.

Figure 4 Macroscopic findings on autopsy. A: The liver weighed 1856 g; B: The spleen 1572 g indicating hepatosplenomegaly.

Figure 5 Microscopic findings on autopsy stained with hematoxylin and eosion. A: Liver; B: Spleen. Both the liver and the spleen showed extramedullary hemopoiesis.

Figure 6 Microscopic findings on autopsy (bone marrow). A: Hematoxylin and eosion (HE), × 10; B: HE, × 40; C: Silver, × 10. Adipocyte disappearance and 3-lineage differentiation were seen. Silver staining showed severe fibrosis with mainly argyrophilic fibers.