Acute Myeloid Leukemia Presenting as Myeloid Sarcoma with a Predisposition to the Gynecologic Tract

Abstract

Myeloid sarcoma (MS) is a rare, extramedullary tumor consisting of immature white blood cells of myeloid lineage. MS is usually associated with the concurrent diagnosis of acute myeloid leukemia (AML) but can also present in the absence of bone marrow disease or at relapse of AML. MS of the gynecologic tract is exceedingly rare; however, it is hypothesized that it is likely more prevalent than previously understood given postmortem findings and persistence in preserved ovarian tissue. There is minimal literature surrounding MS and extramedullary relapse with no clear guidelines. This is a case report of a 48-year-old woman with MS involving the uterine corpus, fallopian tubes, and left ovary followed by a literature review. The overall aim is to review data regarding leukemic immune evasion and sanctuary sites in order to raise awareness as this represents an important and underrecognized hematologic malignancy in an often misdiagnosed, underrecognized site.

The histopathologic examination of a second muscle biopsy specimen at a later date may sometimes be the best approach to make a differential diagnosis in neuromuscular disorders

“…In our case, it was located in the left ovary. The tumor diameter ranged from microscopic size to 25 cm (25,28). The size of the tumor in our case was 9x8.5 cm.…”

“…The patient ages in the case reports ranged from 3 months to 58 years. The mean age of the patients was 32.1 years (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). Most of the patients were in the reproductive age.…”

“…The patients presented with complaints of abdominal pain (8/15), mass (2/15), cough (1/15), and vaginal bleeding (1/15), and the pathology was detected in 3 patients (3/15) during a routine check (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). The tumor was located in the left ovary in 5 cases, the right ovary in 8 cases, and bilaterally in 3 cases (15,19,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). In our case, it was located in the left ovary.…”

“…After myeloid sarcoma diagnosis, AML developed in 8 cases (16,(21)(22)(23)26,(30)(31)(32). Bone marrow involvement was seen simultaneously with myeloid sarcoma in 2 cases (20,28). Before the mass developed in the ovary, six patients had AML and 1 patient had chronic myeloid leukemia (14,17,19,24,29).…”

Myeloid sarcoma of uterine cervix: A case report with review of the literature

“…Myeloid sarcoma (MS) describes a tumour mass consisting of myeloid blasts occurring at an anatomical site out with the bone marrow (BM). It can occur in isolation or precede the onset of leukaemia and is described as non-leukaemic MS in such cases ( Kahn et al, 2019 ). It is important to note that almost half of all patients with non-leukaemic MS will develop acute leukaemia with reported interval rates of 5–11 months ( Yamauchi and Yasuda, 2002 ).…”