We present the case of a 40-year-old patient with β-Thalassemia major who underwent decompressive palliative radiotherapy on symptomatic intracanal extra medullary hematopoiesis on three occasions between 2016 and 2020. We delivered normo-fractionated radiotherapy at a dose of 10Gy in five fractions on vertebrae T4 to T10 and L3 to S2, 20Gy in ten fractions on vertebrae C7 to T11, and 12Gy in six fractions on vertebrae C7 to T9. The treatment was well tolerated with complete recovery of the symptomatology during the first two irradiations, and almost complete recovery after the 3rd irradiation.

BACKGROUND: Adrenal myelolipoma with extramedullary hematopoiesis (EMH) is a rare condition.
METHODS: We report a case of 48-year-old woman suffering from recurrent right hypochondrial pain for two years. Laboratory work-up revealed chronic microcytic iron deficiency anemia with beta thalassemia trait, right adrenal myelolipoma with histopathological evidence of hematopoietic cells (EMH). The patient underwent open resection of the adrenal gland and the post-operative course was uneventful.
CONCLUSIONS: EMH could be presented with several clinical hematological disorders. Surgical management becomes inevitable in certain adrenal EMH cases especially in the presence of a large adrenal mass.

Thalassemia is a hematologic disorder that causes ineffective hematopoiesis and is related to severe anemia, iron overload, extramedullary hematopoiesis, and hepatomegaly. Hepatomegaly is related to significant extramedullary hematopoiesis. The other sites that are involved in extramedullary hematopoiesis are spleen, lymph nodes, paraspinal regions, kidney, pleura, and intestine, but intracranial involvement is a rare presentation. We discuss about a case with intracranial medullary hematopoiesis in a thalassemic patient.