Intestinal obstruction caused by extramedullary hematopoiesis and ascites in primary myelofibrosis

Figure 1 Plain abdominal radiography revealed incomplete small intestinal obstruction. A: The flat film of the abdomen in the standing position showed dilated small bowel loops with air-fluid levels; B: The flat film of the abdomen in the horizontal position showed dilated small bowel.

Figure 2 Computerized tomography images indicated hepatosplenomegaly and ascites (A) and the presence of thickened intestinal wall with obvious enhancement in the arterial phase and dilated small bowel (B-D). A: Plain computerized tomography (CT) scan; B: Coronal CT scan; C: Plain CT scan; D: The arterial phase.

Figure 3 Exploratory laparotomy revealed intestinal obstruction caused by an intestinal mass approximately 5 cm × 3 cm × 3 cm and intestinal adhesions. A: The intestinal mass; B-C: Intestinal adhesions; D: The brownish-yellow mass with an ulcer.

Figure 4 Extramedullary hematopoietic mass of the small intestine with ulcer and excessive vascular proliferation was confirmed by histopathology. A: A significant quantity of Megakaryocytes along with the accumulation of immature myeloid cells and erythroid cells were observed; B: Megakaryocytes were CD61 positive and CD68 negative (not shown); C: Significant hyperplasia of blood vessels and a large number of infiltrated inflammatory cells were seen; D: Blood vessels were confirmed by positive CD31 staining.