Extramedullary hematopoiesis presenting as a large adrenal mass mimicking adrenocortical carcinoma in a primary myelofibrosis patient: A case report.

Extramedullary hematopoiesis (EMH) is a compensatory process associated with chronic bone marrow failure and rarely involves the adrenal gland. We present a 63-year-old woman with abdominal pain and a large heterogeneous right suprarenal mass with calcifications and central necrosis raising suspicion for adrenocortical carcinoma. Laboratory evaluation revealed severe anemia and bone marrow examination confirmed primary myelofibrosis. Due to radiologic and core needle biopsy suspicion of malignancy, surgical resection was performed. Histopathological examination demonstrated extramedullary hematopoiesis composed of erythroid and myeloid precursors with scattered megakaryocytes. This case highlights adrenal EMH as a diagnostic pitfall mimicking adrenal malignancy clinically, radiologically, and histopathologically.