Page 21 - Delaware Medical Journal July 2015

CASE REPORT
specimen contained 9 percent blasts and 39 percent monocytes. The blasts present expressed CD45, CD34, CD13, CD117, and weak HLADR. Curettage of the uterus produced approximately 100mL of blood clot and tissue. Pelvic ultrasound was later obtained which revealed a uterus measuring 15 x 6.9 x 7.8 cm and an endometrial stripe of 20mm.
Subsequent to the dilation and curettage
of the uterus, the patient was given four intravenous doses of 1.25mg of estrogen followed by 40mg of oral megestrol four times daily. Decitabine for treatment of her AML was also initiated at that time. All of the above treatments resulted in improved vaginal bleeding and the patient was subsequently discharged home in stable condition. At that time her hemoglobin was 8.2g/dL and platelet count was 38/nL.
Approximately two weeks following the initial dilation and curettage of the uterus, the patient returned to the
hospital with increased vaginal bleeding. She reported passing “orange-sized” blood clots and necessary pad changes approximately every hour. Laboratory analysis at that time revealed a white blood cell count of 2/nL, hemoglobin
of 4.8g/dL, and platelet count of 14/nL. A gynecologic-oncology consult was obtained and recommended treatment consisted of pelvic radiotherapy.
Pelvic radiotherapy was completed and resulted in improvement of her vaginal following radiotherapy, she was admitted to the hospital again with heavy vaginal bleeding. At that time, her AML was in remission. She reported that over the week prior to admission, she began to pass clots that were “baseball-sized.” Laboratory analysis at that time revealed a white blood cell count of 0.9/nL, hemoglobin of 3.7g/dL, and platelet count of 11/nL.
A uterine artery embolization (UAE) was
FIGURE 1
Low power view of endometrial biopsy demonstrating numerous mononuclear cells amidst benign glandular tissue.
performed which resulted in improved vaginal bleeding. She was subsequently discharged home. Her vaginal bleeding remained stable. The patient expired approximately two months later; eight months from the time of initial AML diagnosis.
DISCUSSION
Extramedullary manifestations of
AML can affect every organ; however involvement of the gynecologic tract
is uncommon. This can make accurate diagnosis of granulocytic sarcoma challenging for pathologists. The most common misdiagnosis is lymphoma, carcinomas, and epithelioid sarcomas have also been reported after histologic examination. Cytochemical and immunohistochemical studies can be used to reliably make an accurate diagnosis in nearly all cases.3
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