# 髓外造血（Extramedullary Hematopoiesis）

- 器官 / 系统：肾上腺 / 内分泌系统（adrenal-gland / endocrine-system）
- NTP 数据编号：ntp-0088
- 规范 URL：https://www.labsmart.cn/ntp/adrenal-gland-extramedullary-hematopoiesis.html
- 中文图谱总页锚点：https://www.labsmart.cn/ntp-atlas.html#adrenal-gland-extramedullary-hematopoiesis
- 原始出处：https://ntp.niehs.nih.gov/atlas/nnl/endocrine-system/adrenal-gland/ExtramedullaryHematopoiesis
- 授权：美国联邦政府作品，公有领域；引用请标注 NTP Nonneoplastic Lesion Atlas
- 适用说明：仅供科研使用，不用于临床诊断

## 一句话结论
髓外造血（extramedullary hematopoiesis，EMH）可发生于多种组织，包括肾上腺皮质和髓质。

## 病变描述（中文）
髓外造血（extramedullary hematopoiesis，EMH）可发生于多种组织，包括肾上腺皮质和髓质。EMH在肾上腺中不常见，因此若存在，很可能也存在于其他器官，最可能是脾和肝（见脾-髓外造血和肝-髓外造血）。EMH通常由混合的髓系造血细胞和红系造血细胞组成，但也可主要（罕见情况下完全）由其中某一谱系组成。髓外髓系造血通常继发于各种炎症或免疫反应，是对需要额外白细胞的一种反应。髓外红系造血常常是对某些类型贫血（例如溶血性贫血或失血）以及某些导致缺氧的情况（例如呼吸系统疾病）的一种反应。大鼠、尤其是小鼠肾上腺中的低级别EMH也可在没有任何明确诱因的情况下发生。肾上腺EMH由大小不一、无压迫性的未成熟造血细胞和/或巨核细胞簇组成，散布于皮质和/或髓质（Figure 1、Figure 2、Figure 3、Figure 4、Figure 5、Figure 6）。髓系造血细胞通常大于红系造血细胞，且胞质更多，而红系造血细胞通常颜色深得多。肾上腺EMH必须与炎症（成熟白细胞，常伴有组织坏死或变性）以及全身性淋巴或造血肿瘤性浸润（低分化、常为间变性细胞，通常呈广泛聚集，使正常结构扭曲或破坏）相鉴别。

## 诊断与分级建议（NTP 共识，中文）
只有当肾上腺髓外造血（EMH）的发生率和/或严重程度出现与处理相关的增加时，才应作出诊断并赋予严重程度分级。作出诊断时，诊断中应包含部位修饰词（即皮质或髓质），以指明病变的位置。如果EMH同时存在于皮质和髓质，可省略部位修饰词，并在病理学描述中说明位置。如果双侧肾上腺均可见EMH，应在诊断中加入修饰词“双侧（bilateral）”（除非另有说明，病变假定为单侧）。如果病变主要由某一特定细胞谱系（例如髓系造血或红系造血）组成或完全由该谱系组成，应在病理学描述中说明。相关链接：肝-髓外造血 脾-髓外造血

## 英文原文 · Comment
Extramedullary hematopoiesis (EMH) can occur in various tissues, including the adrenal cortex and medulla. EMH is not commonly seen in the adrenal gland, so if it is present, it will likely also be present in other organs, most likely the spleen and liver (see Spleen - Extramedullary Hematopoiesis and Liver - Extramedullary Hematopoiesis ). EMH is typically composed of mixed myelopoietic and erythropoietic cells but may be primarily (rarely exclusively) composed of one or the other lineage. Extramedullary myelopoiesis is usually secondary to various inflammatory or immune responses and is a reaction to the need for additional white blood cells. Extramedullary erythropoiesis is frequently a response to certain types of anemia (e.g., hemolytic anemia or blood loss) and some situations leading to hypoxia (e.g., respiratory disease). Low-grade EMH in the adrenal gland of rats and especially mice can also occur without any clear inciting cause. Adrenal EMH consists of variably sized, noncompressive clusters of immature hematopoietic cells and/or megakaryocytes scattered throughout the cortex and/or medulla ( Figure 1 , Figure 2 , Figure 3 , Figure 4 , Figure 5 , and Figure 6 ). Myelopoietic cells are typically larger than erythropoietic cells and have more cytoplasm, whereas erythropoietic cells typically are much darker. Adrenal EMH must be distinguished from inflammation (mature leukocytes, often associated with tissue necrosis or degeneration) and from systemic lymphoid or hematopoietic neoplastic infiltrates (poorly differentiated, often anaplastic cells usually in extensive accumulations that distort or obliterate normal architecture).

## 英文原文 · Recommendation
Adrenal extramedullary hematopoiesis (EMH) should be diagnosed and assigned a severity grade only if there are treatment-related increases in incidence and/or severity. When it is diagnosed, a site modifier (i.e., cortex or medulla) should be included in the diagnosis to indicate the location of the lesion. If EMH is present in both the cortex and medulla, the site modifier may be omitted and the location described in the pathology narrative. If EMH is seen in both adrenal glands, the modifier "bilateral" should be added to the diagnosis (lesions are assumed to be unilateral unless otherwise indicated). If the lesion is composed primarily or exclusively of a particular cell lineage (e.g., myelopoietic or erythropoietic), this should be indicated in the pathology narrative. Related Links: Liver - Extramedullary Hematopoiesis Spleen - Extramedullary Hematopoiesis

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