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Mentions: On examination, she was in perfect physical condition, no history of weight loss, fever, or night sweats, and the blood pressure was 110/70 mm Hg. Gynecologic examination revealed an enlarged cervix, which was firm, elastic and bruised easily without parametrial or vaginal cul-de-sac involvement. There were no palpable lymph nodes and no hepatosplenomegaly. The rest of the physical examination was normal. Laboratory studies revealed the following values: hemoglobin 13.3 g/dL, platelet 218 × 103/mL, and white-cell count 7300 per cubic millimeter, with 62.5% neutrophils, 30.2% lymphocytes, and 5.3% monocytes. Blood chemistry was unremarkable. Cytological examination of cervical smears was composed of 50% of hematopoietic cells, small to medium sized blasts, with high nuclears-cytoplasmic ratio, fine chromatin, and fine granulations in the cytoplasm of myeloid origin. The blasts were myeloperoxidase positive. A biopsy was performed (two fragments of 1.3 × 0.5 × 0.2 and 1.1 × 0.7 × 0.2 cm) which showed extensive infiltration of the squamous epithelium wall by small-sized blast cells. Multiple immunohistochemical analyses were obtained. Myeloperoxidase, Common leucocytic antigen, and CD34 were strongly positive. (Figures 1 and 2) Lymphoid markers, epithelial markers, and neuroendocrine markers were all negative (CD20, CD3, CD23, CD5, CD10, CD68, CD45 RO, Kappa, Lambda, cytokeratin, EMA, synaptophysin, and chromogranin). The Ki67 was expressed in 80% of the cells. These findings were compatible with the diagnosis of a GS of the myeloblastic type. Bone marrow biopsy (BMB) and aspirate were normal as were cytogenetics.
Successful Treatment of a Granulocytic Sarcoma of the Uterine Cervix in Complete Remission at Six-Year Follow-Up
Bottom Line: 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.
Affiliation: Department of Hematology and Oncology, Centre des Hôpitaux Universitaires de Strasbourg, BP 67000, Strasbourg, France.
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.