The Quantification and Significance of Extramedullary Hematopoiesis Seen on Liver Biopsy Specimens

Objectives: Extramedullary hematopoiesis (EMH) may occur in the liver and is often considered pathologic in adults. Many hematologic and nonhematologic disorders are associated with the development of EMH. However, it is unclear whether the presence of EMH is always pathologic. At present, no formal grading system for EMH in the liver exists. Methods: We reviewed 42 liver biopsy specimens with EMH and developed a novel grading system to quantify the degree of EMH from 1 to 3 based on the number of EMH foci in 10 high-power fields. Results: Most patients had nonhematologic conditions (n = 25). Seventeen patients had a hematologic condition, most frequently a myeloproliferative neoplasm (n = 9). Patients with an underlying hematologic condition had a significantly higher EMH grade compared with those without a hematologic condition (P < .0001). All patients with grade 3 EMH had an underlying hematologic diagnosis, and most (86%) patients with grade 1 EMH had a nonhematologic disorder. Conclusions: Our data suggest that EMH grading in the liver is feasible and can identify patients who may have an underlying hematologic condition, which can guide further diagnostic workup.