Six weeks later, 3 months before this evaluation, the patient was seen in follow-up by her internist. The vital signs and examination were normal; laboratory-test results are shown in Table 1TABLE 1
Laboratory Data.
. The following week, a percutaneous, CT-guided needle biopsy of a right paravertebral mass was performed at another hospital; pathological examination of the tissue revealed maturing myeloid and erythroid precursors and megakaryocytes, features consistent with extramedullary hematopoiesis (myeloid metaplasia).
Seventeen days before this evaluation, the patient was evaluated by a hematologist at another hospital. Serum levels of electrolytes, glucose, and lactate dehydrogenase were normal, as were tests of renal and liver function. Examination of a peripheral-blood smear revealed moderate hypochromia, microcytosis, and anisocytosis and occasional elliptocytes, schistocytes, teardrop red cells, and polychromatophilic red cells; other test results are shown in Table 1. Additional test results were pending.