Primary relapse of acute lymphoblastic leukemia in a cervical smear: A case report

Abstract

Uterine cervix and corpus are rarely the initial site of relapse in leukemia or lymphoma. We report herein a case of uterine cervical relapse with B-cell acute lymphoblastic leukemia (ALL). The patient, a 60-yr-old woman, had a history of ALL that had been in remission for 2 yr after chemotherapy. She presented with a chief complaint of genital bleeding. In a routine cervico-vaginal Papanicolau smear, abundant atypical lymphoid cells with round-to-oval nuclei, scant cytoplasm, and high nuclear to cytoplasmic ratios was observed. The nuclei of these cells had fine and dark chromatin and thickened nuclear membranes, with one or several nucleoli being visible. Biopsy under colposcope was performed, and a diagnosis of relapse of ALL was confirmed. The ongoing genital bleeding presented a problem with clinical management of the patient. It was decided to proceed with hysterectomy to end that problem and thereafter proceed with therapy directed against the leukemia. Our results suggest that in patients with known extrauterine cancer, the presence of malignancy in uterine cellular samples provides information regarding the extent of the neoplasm.

Vaginal Lymphoma with Immune Thrombocytopenic Purpura: An Unusual Case Report

“…In previously reported cases, vaginal lymphoma resulted in ill-defined thickening or induration of the vaginal wall [5, 7]. In our previous report of a case of uterine cervical acute lymphoblastic leukemia (ALL) extended into the vagina, the vaginal wall was macroscopically thickened [8], but in the present case, the vaginal wall was not hard or thickened.…”

“…Several authors have reported lymphoid neoplasms such as lymphoma and leukemia manifesting in gynecological organs [3,4,5,6,7,8,9,10], but the total number of such cases remains small. In autopsy studies of patients with NHL, the uterus was found to be involved in approximately 0.5% of cases and the vagina in 2% [4].…”

Nevoid melanoma of the vagina: report of one case diagnosed on thin layer cytological preparations

“…Most hematological malignancies may primarily or secondarily involve the genital tract: in our case lymphoblastic [15] or myeloid [16] leukemia could have been excluded based on the cell size and nucleo/cytoplasmic fetures, while high grade non-Hodgkin lymphoma [17] and anaplastic myeloma [18] could have been the only possible differential due to the nucleolar prominence and large cell size. Some nucleo-cytoplasmic features of the cell population in our case, however, would have strongly dictated against these two entities: the presence of peripheral ring-like cytoplasmic condensations, of irregular cytoplasmic borders evoking hyperplastic microvilli and the extremely lobulated and convoluted shape of the nuclear membrane: this latter seemed excessive even for a high grade lymphoma of convoluted cell type.…”

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

“…Amongst genitourinary organs, testis is the most common site of involvement in ALL [8]. Cases of ovarian and cervix involvement in ALL are limited to case reports only [9][10][11][12][13].…”