Sclerosing extramedullary hematopoietic tumor involving lesser omentum and ligamentum teres in liver explant

A 47-year-old patient who presented with a 2-year history of hepatitis B virus-associated liver cirrhosis underwent a liver transplantation. The explanted liver was grossly enlarged and diffusely cirrhotic. The lesser omentum and ligamentum teres revealed a 4 cm ill-defined mass that, on sectioning, showed a gray-white appearance. Extramedullary hematopoiesis on a fibrosclerotic background constituted this mass, but there was also extramedullary hematopoiesis within the liver cords and possibly within the omentum. A bone marrow study also showed chronic idiopathic myelofibrosis. Acute rejection ensued despite immunosuppression and the patient continued to deteriorate and expired. Sclerotic extramedullary hematopoietic tumor is rare, has an unfavorable prognosis, and may mark the end stage of chronic myeloproliferative disorder.