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Wang JX, Zhang H, Ning G, Bao L. Vulvovaginal myeloid sarcoma with massive pelvic floor infiltration: A case report and review of literature. World J Clin Cases 2022; 10:8312-8322. [PMID: 36159511 PMCID: PMC9403691 DOI: 10.12998/wjcc.v10.i23.8312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/13/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Myeloid sarcoma (MS), including isolated and leukaemic MS, is an extramedullary myeloid tumour. MS can involve any anatomical site, but MS of the female genital tract is rare, with the ovaries and uterine body and cervix being the most commonly seen sites. Involvement of the vagina and vulva is extremely rare.
CASE SUMMARY We report a rare case of MS with involvement of the vulva and vagina and massive infiltration of the pelvic floor. A 26-year-old woman presented with a vulvar mass, irregular vaginal bleeding and night sweats. Magnetic resonance imaging demonstrated an ill-defined, irregular vulvovaginal mass with massive involvement of the paravaginal tissue, urethra, posterior wall of the bladder, and pelvic floor. The signal and enhancement of the huge mass was homogeneous without haemorrhage or necrosis. Positron emission tomography/computed tomography showed high fluorodeoxyglucose uptake by the mass. Peripheral blood count detected blast cells. Vulvovaginal mass and bone marrow biopsies were performed, and immunohistochemistry confirmed the diagnosis of acute myeloid leukaemia (M-2 type, FAB classification) and vulvovaginal MS. The patient was treated with induction chemotherapy followed by allogeneic haematopoietic stem cell transplantation, and achieved complete remission. A systemic review of the literature on vulvovaginal MS was conducted to explore this rare entity’s clinical and radiological features.
CONCLUSION Vulvovaginal MS is extremely rare. Diagnosis of vulvovaginal MS can only be confirmed histopathologically. Even though its clinical and imaging presentations are nonspecific, MS should be considered in the differential diagnosis of a newly developed T2-hyperintense, homogeneously enhanced vulvovaginal mass, especially in a patient with suspected haematological malignancy.
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Affiliation(s)
- Jia-Xi Wang
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education; West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Radiology, Renshou Maternity and Child Health Hospital, Meishan 620500, Sichuan Province, China
| | - Heng Zhang
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education; West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Gang Ning
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education; West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li Bao
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education; West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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2
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Jadhav T, Baveja P, Sen A. Myeloid sarcoma: an uncommon presentation of myeloid neoplasms; a case series of 4 rare cases reported in a tertiary care institute. Autops Case Rep 2021; 11:e2021339. [PMID: 34805008 PMCID: PMC8597781 DOI: 10.4322/acr.2021.339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/04/2021] [Indexed: 11/23/2022]
Abstract
Myeloid sarcoma (MS) is a rare extramedullary neoplasm of myeloid cells, which can arise before, concurrently with, or following hematolymphoid malignancies. We report 04 such cases of MS, diagnosed in this institute over a period of 6 years, during various phases of their respective myeloid neoplasms/leukemias. These cases include MS occurring as a relapse of AML (Case 1), MS occurring as an initial presentation of CML (Case 2), MS occurring during ongoing chemotherapy in APML (Case 3), and MS presenting as a progression of MDS to AML (Case 4). In the absence of relevant clinical history and unemployment of appropriate immunohistochemical (IHC) studies, these cases have a high risk of being frequently misdiagnosed either as Non-Hodgkin’s Lymphoma (NHL) or small round cell tumors or undifferentiated carcinomas, which may further delay their management, making an already bad prognosis worse. This case series has been designed to throw light on the varied presentation of MS and the lineage differentiation of its neoplastic cells through the application of relevant IHC markers along with their clinical correlation.
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Affiliation(s)
- Toyaja Jadhav
- Armed Forces Medical College, Department of Pathology, Pune, Maharashtra, India
| | - Puneet Baveja
- Armed Forces Medical College, Department of Pathology, Pune, Maharashtra, India
| | - Arijit Sen
- Armed Forces Medical College, Department of Pathology, Pune, Maharashtra, India
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3
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An Exceptional Vulvar Tumor: Myeloid Sarcoma of the Labia Majora. Int J Gynecol Pathol 2019; 39:111-114. [PMID: 30829759 DOI: 10.1097/pgp.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Vulvar malignancies are rare and have diverse origins and presentations. The majority of these tumors are squamous cell carcinoma. An ulcerating vulvar tumor was found in a 74-yr-old woman presenting with fatigue and leukocytosis. Tumor biopsy revealed infiltration of blastoid cells from myeloid origin. Through bone marrow aspiration chronic myelomonocytic leukemia was diagnosed, of which the vulvar tumor was a rare extramedullary disease manifestation termed myeloid sarcoma. Limited palliative treatment was instated with a focus on the patient's quality of life. Myeloid sarcoma (chloroma; granulocytic sarcoma) is a mass of myeloblasts occurring in cases of myeloid disease. Manifestations in most organ systems have been described. Presentation in gynecologic areas is reported in a few case reports, to which we now add our experience.
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4
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Missaoui N, Mestiri S, Bdioui A, Zahmoul T, Hamchi H, Mokni M, Hmissa S. HPV infection and p16 INK4A and TP53 expression in rare cancers of the uterine cervix. Pathol Res Pract 2018; 214:498-506. [PMID: 29572122 DOI: 10.1016/j.prp.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/10/2018] [Accepted: 03/02/2018] [Indexed: 01/04/2023]
Abstract
Cervix cancer remains among most commonly diagnosed cancer in developing countries. Except squamous cell carcinoma and adenocarcinoma, the etiopathology and oncogenic mechanisms of rare cancers remain largely unknown. The study was performed to investigate the value of HPV infection and the expression of p16INK4A and TP53 in rare primitive cancers of the cervix. We conducted a retrospective study of rare primitive cancers of the cervix. Main clinicopathological features were reported. HPV infection was detected by in situ hybridization. Expression of p16INK4A and TP53 was analyzed by immunohistochemistry. Overall, seven cases were identified, including basaloid squamous cell carcinoma (BSCC, n = 2), small cell neuroendocrine carcinoma (SCNEC), granulocytic sarcoma without acute myeloid leukemia, leiomyosarcoma, primitive neuroectodermal tumor and botryoid-type embryonic rhabdomyosarcoma. The mean age of patients was 53.7 years. Four cancers were diagnosed at advanced stages. The prognosis was unfavorable and associated with patient death in five cases. HPV types 16/18 were detected in BSCCs and SCNEC. Strong and diffuse p16INK4A overexpression was described in the nucleus and the cytoplasm of all tumor cells of BSCCs and SCNEC. The remaining cancers exhibited only scattered and focal p16INK4A staining. Mutated TP53 protein was detected in BSCC (case 1) and GS. Rare cancers of the cervix are aggressive and associated with poor prognosis. In contrast to mesenchymal tumors, BSCCs and SCNEC are etiologically related to high-risk HPV infection and could be identified by block positive p16INK4A overexpression as common cancers of the cervix. TP53 mutations are not a negligible genetic event in rare cervical cancers.
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Affiliation(s)
- Nabiha Missaoui
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia; Faculty of Sciences and Technologies of Sidi Bouzid, University of Kairouan, Tunisia.
| | - Sarra Mestiri
- Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Ahlem Bdioui
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Thouraya Zahmoul
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Hajer Hamchi
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Moncef Mokni
- Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
| | - Sihem Hmissa
- Research Unit UR14ES17, Cancer Epidemiology and Cytopathology in Tunisian Center, Medicine Faculty, 4002 Sousse, Tunisia; Pathology Department, Farhet Hached Hospital, 4000 Sousse, Tunisia
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5
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George SM, Chandran N, Malik AK. Granulocytic sarcoma of ovary in a post allogenic bone marrow transplant patient – A diagnostic challenge to the anatomic pathologist. Case report and review of literature. J OBSTET GYNAECOL 2016; 36:567-70. [DOI: 10.3109/01443615.2015.1110124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sara Mathew George
- Department of Pathology, Salmaniya Medical Centre, Manama, Kingdom of Bahrain
| | - Nisha Chandran
- Department of Pathology, Salmaniya Medical Centre, Manama, Kingdom of Bahrain
| | - Ashok Kumar Malik
- Department of Pathology, Salmaniya Medical Centre, Manama, Kingdom of Bahrain
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6
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Primary vaginal myeloid sarcoma: a rare case report and review of the literature. Case Rep Obstet Gynecol 2015; 2015:957490. [PMID: 25685570 PMCID: PMC4313514 DOI: 10.1155/2015/957490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/18/2014] [Accepted: 12/27/2014] [Indexed: 12/12/2022] Open
Abstract
Myeloid sarcoma (chloroma, granulocytic sarcoma, or extramedullary myeloid tumour) is an extramedullary mass forming neoplasm composed of myeloid precursor cells. It is usually associated with myeloproliferative disorders but very rarely may precede the onset of leukemia. Here, we are presenting a rare case of primary vaginal myeloid sarcoma in a geriatric female patient without initial presentation of acute myeloid leukemia (AML). A 68-year-old female patient with ECOG Performance Score of 1 presented with pervaginal bleeding for 20 days. On colposcopic examination, she was found to have mass in the anterior fornix of vagina. A punch biopsy specimen revealed chloromatous infiltration of the vagina. LCA (leukocyte common antigen), MPO (myeloperoxidase), and c-kit were strongly positive on IHC (immunohistochemistry). The patient's routine blood investigations were normal including peripheral smear, lactose dehydrogenase, uric acid, 2D echocardiography, conventional cytogenetics, bone marrow aspiration, and biopsy. The patient was given 4 cycles of decitabine (Decitex, manufactured by Sun Pharmaceutical Industries Limited, India), 20 mg/m(2) for 5 days at an interval of 28 days. There was a partial response to decitabine according to RECIST criteria. As decitabine therapy was well tolerated, we are continuing in the same way until disease progression without any complications. The patient is undergoing regular follow-up at our centre.
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7
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Myeloid sarcoma of the uterine cervix presenting as missed abortion. Arch Gynecol Obstet 2012; 286:1339-41. [PMID: 22791383 PMCID: PMC3472052 DOI: 10.1007/s00404-012-2454-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 07/02/2012] [Indexed: 11/16/2022]
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8
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Granulocytic sarcoma of the cervix. J Obstet Gynaecol India 2010. [DOI: 10.1007/s13224-010-0034-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Successful treatment of a granulocytic sarcoma of the uterine cervix in complete remission at six-year follow-up. JOURNAL OF ONCOLOGY 2010; 2010:812424. [PMID: 20454648 PMCID: PMC2862322 DOI: 10.1155/2010/812424] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2009] [Accepted: 02/23/2010] [Indexed: 11/17/2022]
Abstract
Background. Localized granulocytic sarcoma of the uterine cervix in the absence of acute myelogenous leukemia (AML) at presentation is very rare, its diagnosis is often delayed, and its prognosis almost always ominous evolving into refractory AML. Case. We present the case of a 30-year-old woman with vaginal bleeding and a large cervical mass. Further evaluation confirmed the presence of a granulocytic sarcoma but failed to reveal systemic involvement. Results. AML type chemotherapy followed by radiotherapy of the uterus led to a durable complete remission. She remains in complete remission six years after diagnosis. Conclusion. Granulocytic sarcoma of the cervix is a rare entity for which early intensive AML type therapy is effective.
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10
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Postmenopausal bleeding as first sign of an acute myelogenous leukaemia: A case report and review of the literature. Med Oncol 2009; 27:815-9. [PMID: 19763918 DOI: 10.1007/s12032-009-9291-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 08/06/2009] [Indexed: 12/24/2022]
Abstract
Postmenopausal bleeding (PMB) can have various causes and malignancy must always be excluded. Extramedullary manifestations of a haematological disease in the female genital tract are rare. We present the case of a woman with PMB as the first sign of an acute myelogenous leukaemia (AML). An 81-year-old patient presented with PMB. Manual and colposcopic examination raised suspicion of a cervical carcinoma, but histopathology and cervical Pap smear altered the diagnosis to granulocytic sarcoma (GS), an extramedullary manifestation of AML. The patient had a normal blood count 2 weeks prior to the examination, but at the time of presentation her leukocytes had risen to 116000/microl. The patient died 3 days later due to a pulmonary embolism, most probably as a result of leukostasis. In this case, GS of the cervix was the first sign of the AML with simultaneous appearance of leukocytosis and peripheral blasts. PMB was the reason for presentation. GS of the female genital tract is very rare and diagnosis is challenging, especially on the basis of the Pap smear. Abnormal inflammatory cells must be a warning sign and an indication for further examinations. GS as the presenting sign of AML has a poor prognosis with only 6% of patients surviving for more than 2 years.
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11
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Hanley KZ, Tadros TS, Briones AJ, Birdsong GG, Mosunjac MB. Hematologic malignancies of the female genital tract diagnosed on liquid-based Pap test: Cytomorphologic features and review of differential diagnoses. Diagn Cytopathol 2009; 37:61-7. [DOI: 10.1002/dc.20994] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Fulciniti F, Ascierto PA, Simeone E, Bove P, Losito S, Russo S, Gallo MS, Greggi S. Nevoid melanoma of the vagina: report of one case diagnosed on thin layer cytological preparations. Cytojournal 2007; 4:14. [PMID: 17608945 PMCID: PMC1934920 DOI: 10.1186/1742-6413-4-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 07/03/2007] [Indexed: 11/13/2022] Open
Abstract
Background Primary melanoma of the vagina is an extremely rare neoplasm with approximately 250 reported cases in the world literature [1-4]. In its amelanotic variant this lesion may raise several differential diagnostic problems in cytological specimens [5]. In this setting, the usage of thin layer cytopathological techniques (Liquid Based Preparations = LBP) may enhance the diagnostic sensitivity by permitting immunocytochemical study without having to repeat the sampling procedure. The aim of this paper is to describe the cytomorphological presentation of primary vaginal melanoma on LBP since it has not previously been reported up to now, to our knowledge. Case presentation a 79-y-o female complaining of vulvar itching and yellowish vaginal discharge underwent a complete gynaecological evaluation during which a LBP cytological sample was taken from a suspicious whitish mass protruding into the vaginal lumen. A cytopathological diagnosis of amelanotic melanoma was rendered. The mass was radically excised and the patient was treated with α-Interferon. Conclusion amelanotic melanoma may be successfully diagnosed on LBP cytological preparations. Thin layer preparations may enhance the diagnostic cytomorphological clues to its diagnosis and may permit an adequate immunocytochemical characterization of the neoplasm.
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Affiliation(s)
- Franco Fulciniti
- Section of Cytopathology and Dept. of Pathology, National Cancer Institute, Naples, Italy
| | | | - Ester Simeone
- Dept of Experimental Oncology, National Cancer Institute, Naples, Italy
| | - Patrizia Bove
- Section of Cytopathology and Dept. of Pathology, National Cancer Institute, Naples, Italy
| | - Simona Losito
- Section of Cytopathology and Dept. of Pathology, National Cancer Institute, Naples, Italy
| | - Serena Russo
- Section of Cytopathology and Dept. of Pathology, National Cancer Institute, Naples, Italy
| | - Maria Stella Gallo
- Dept of Gynecological Oncology, National Cancer Institute, Naples, Italy
| | - Stefano Greggi
- Dept of Gynecological Oncology, National Cancer Institute, Naples, Italy
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13
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Ko SW, Kim YK, Jin GY, Lee SY, Kim CS. Granulocytic sarcoma manifested as a parametrial mass mimicking a haemorrhagic abscess: a case report with CT and MR findings. Br J Radiol 2007; 80:e128-30. [PMID: 17704306 DOI: 10.1259/bjr/60325018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Granulocytic sarcoma is a neoplasm arising from myeloid precursor cells and frequently accompanies leukaemia and myeloproliferative disorders. Granulocytic sarcoma can arise anywhere, and it frequently involves bones, perineural tissues and lymph nodes. However, granulocytic sarcoma in the female genital organs is uncommon, and it is extremely rare that it presents as an adnexal or parametrial mass. We report here the CT and MR findings in a case of granulocytic sarcoma that manifested as a uterine cervical and parametrial mass mimicking a haemorrhagic abscess in a 50-year-old woman with chronic myelogenous leukaemia.
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MESH Headings
- Abscess/diagnosis
- Cervix Uteri/diagnostic imaging
- Cervix Uteri/pathology
- Diagnosis, Differential
- Female
- Hemorrhage/diagnosis
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnostic imaging
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology
- Magnetic Resonance Imaging, Interventional
- Middle Aged
- Parametritis/diagnostic imaging
- Parametritis/pathology
- Sarcoma, Myeloid/diagnosis
- Sarcoma, Myeloid/diagnostic imaging
- Sarcoma, Myeloid/pathology
- Tomography, X-Ray Computed
- Uterus/pathology
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Affiliation(s)
- S W Ko
- Department of Diagnostic Radiology, Chonbuk University Medical School, 634-18 Geumam 2 dong, Dukjin gu, Jeonju City, Chonbuk, South Korea, 561-712
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14
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Garcia MG, Deavers MT, Knoblock RJ, Chen W, Tsimberidou AM, Manning JT, Medeiros LJ. Myeloid Sarcoma Involving the Gynecologic Tract. Am J Clin Pathol 2006. [DOI: 10.1309/h9mm21fpt7ybl3pw] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Pathak B, Bruchim I, Brisson ML, Hammouda W, Bloom C, Gotlieb WH. Granulocytic sarcoma presenting as tumors of the cervix. Gynecol Oncol 2005; 98:493-7. [PMID: 16019058 DOI: 10.1016/j.ygyno.2005.04.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2004] [Revised: 04/15/2005] [Accepted: 04/18/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Granulocytic sarcoma of the cervix, leading to the diagnosis of acute myelogenous leukemia (AML), is a rare event. CASE A 33-year-old woman presented with vaginal bleeding, pain, and a large pelvic mass involving the cervix, extending bilaterally to the pelvic side walls. A biopsy of the cervix revealed granulocytic sarcoma, and a subsequent bone marrow biopsy confirmed the diagnosis of AML. RESULTS The majority of patients with cervical granulocytic sarcoma present with vaginal bleeding, sometimes with abdominal pain and other systemic symptoms. The overall 2-year survival rates for all patients with granulocytic sarcoma in the literature is 6%, and none of the patients lived 5 years. CONCLUSION Granulocytic sarcoma of the cervix is rare. Awareness of this entity will allow earlier diagnosis and appropriate treatment.
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Affiliation(s)
- Bhuvan Pathak
- Division of Gynecologic Oncology, Sir Mortimer B. Davis Jewish General Hospital, Montreal, Quebec, Canada H3T 1E2
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