title: 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.
authors.affiliation: Department of Obstetrics and Gynecology, Kansai Medical University, Moriguchi Osaka, Japan. ikutaa@takii.kmu.ac.jp
authors.forename: Akiko
authors.initials: A
authors.lastname: Ikuta
authors.forename: Junko
authors.initials: J
authors.lastname: Saito
authors.forename: Tomomi
authors.initials: T
authors.lastname: Mizokami
authors.forename: Masami
authors.initials: M
authors.lastname: Asano
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Nakamoto
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nakajima
authors.forename: Mitsuyo
authors.initials: M
authors.lastname: Matsunami
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yasuda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Adachi
authors.forename: Hideharu
authors.initials: H
authors.lastname: Kanzaki
mesh_terms: D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D014626:Vaginal Smears