Hematologic malignancies of the female genital tract diagnosed on liquid‐based Pap test: Cytomorphologic features and review of differential diagnoses

Abstract

The female genital tract is rarely the primary site for hematologic malignancies; however, secondary involvement of this anatomic site is common. Primary lymphomas of the gynecologic tract are reported to represent less than 1% of extranodal non-Hodgkin lymphomas (NHL), and the majority of them being B-cell in origin. Diffuse large B-cell lymphoma is the most common subtype, whereas primary extraosseus plasmacytoma of the genital tract is rare.If clinically not suspected, these rare tumors pose a diagnostic challenge both for clinicians and pathologists. Clinical symptoms are often nonspecific and mimic other more common gynecologic malignancies such as squamous cell carcinoma of the cervix or endometrial adenocarcinoma. Although cervico-vaginal (Pap) smear is the primary screening method for cervical squamous cell carcinoma and its precursors, it is far less sensitive for detection of other primary or metastatic malignancies. In this review, we present three cases of hematologic gynecologic malignancies, two cases of primary NHL, and a case of acute myeloid leukemia with relapse as a pelvic mass, all of which were diagnosed on a liquidbased Pap test. In addition, we discuss the morphologic features of differential diagnostic entities of these rare tumors on conventional and liquid-based preparations.

Postmenopausal bleeding as first sign of an acute myelogenous leukaemia: A case report and review of the literature

“…Pap smear as a primary screening method for cervical squamous cell carcinoma is only sensitive for this indication. Where there are abnormal findings, it can only alert the physician to initiate further examinations [10]. The correct diagnosis of GS requires the synopsis of all the diagnostic findings, including immunohistochemistry.…”

“…Haematological diseases as the cause of bleeding are very rarely found, but lymphoma [6,10,11], plasmacytoma [7,10] and leukaemia [9,11,17,22,24,28] all can present as PMB. Extramedullary manifestations of acute or chronic myelogenous leukaemia (AML/ CML) are called granulocytic sarcoma (GS) and are described in 3-5% of patients with AML/CML [20].…”

An Unusual Site of Acute Lymphoblastic Leukaemia Relapse: Challenge for Gynaecologists

“…Secondary involvement of female genitourinary system [1,2] is more common in lymphoma than leukaemia [3,4]. In leukaemia, acute myeloid leukaemia (AML) is known to have extra medullary involvement (chloroma, granulocytic sarcoma, etc.)…”

Lymphoma of the cervix uteri

“…Primary malignant lymphoma of the female genital tract is an extremely rare clinical entity;1 involvement of the cervix by lymphoma as part of widespread disease is more common 2 – 4. Clinical symptoms are often non-specific and mimic other more common gynaecological pathology, both benign and malignancies such as squamous cell carcinoma of the cervix or endometrial adenocarcinoma 1.…”

“…Clinical symptoms are often non-specific and mimic other more common gynaecological pathology, both benign and malignancies such as squamous cell carcinoma of the cervix or endometrial adenocarcinoma 1. Clinical awareness of this rare possibility is important to achieve early diagnosis and appropriate management.…”