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bleeding is surgical management, pancytopenia can be considered a contraindication.Thrombocytopenia increases the risk of substantial intraoperative and postoperative hemorrhage, anemia can cause ischemic cardiac events, and neutropenia
makes the patient prone to infection.
with transfusion given the short half-life and rapid fall. Preoperative correction of anemia to hemoglobin greater than 8g/dL is ideal. When pancytopenia is present,
it is recommended that conservative measures be utilized and surgery only be used of other treatment modalities fail.4
Curettage of the uterus is used to treat hemodynamically unstable women with profuse uterine bleeding. It is both diagnostic and therapeutic and can
be performed quickly and result in a
than one hour. However, when curettage is
utilized, medical therapy must be instituted postoperatively to prevent recurrence of the bleeding. High dose intravenous estrogen administration can be used for this purpose.5
It has previously been observed that chemotherapy can induce complete remission and long-term survival in patients affected by granulocytic sarcoma.3 In the above case the standard high intensity induction chemotherapy could not be
used. The patient’s co-morbid conditions, including poorly controlled diabetes mellitus, pulmonary hypertension, and morbid obesity, necessitated chemotherapy induction using decitabine. Although the chemotherapy reduced the vaginal bleeding, it necessitated additional therapies.
Hypofractionated radiotherapy can be used in gynecologic malignancies to uterine bleeding. Bleeding has been shown to be controlled in 45 percent of cases after a single radiotherapy treatment, 85 percent
FIGURE 2
High power view of endometrial biopsy demonstrating numerous mononuclear cells amidst benign glandular tissue.
of cases after two treatments, and 100 percent of cases after three treatments. Various dose fractionation regimens
have been utilized and proven effective. Treatment should be individualized for each patient based on symptoms, etiology, risk of toxicity, and life expectancy.6
Uterine artery embolization is commonly used for treatment of postpartum hemorrhage. It has also been shown to
be effective for uncontrollable uterine bleeding resulting from malignant neoplasms. Although effective, UAE is
a temporizing treatment, as recurrence
in heavy uterine bleeding is common. Additional treatment is required following UAE and typically includes radiotherapy, surgery, or chemotherapy.7
Treatment of uterine granulocytic sarcoma poses multiple challenges that are best met with a multi-disciplinary approach. The above diagnostic and treatment modalities require involvement
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Del Med J | July 2015 | Vol. 87 | No. 7
