title: Extramedullary Relapse of Acute Lymphoblastic Leukemia Presenting as Abnormal Uterine Bleeding: A Case Report.
abstract: BACKGROUND
  Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Relapse of ALL occurs in 15%-20% of patients, with 2%-6% occurring exclusively in extramedullary sites. Relapse of ALL in gynecologic organs is extremely rare.
  
  
  METHODS
  We present a case of a 12-year-old girl with a history of ALL who was referred to the pediatric gynecology clinic with abnormal uterine bleeding. She was determined to have an extramedullary uterine relapse of her ALL.
  
  
  CONCLUSIONS
  Abnormal uterine bleeding in the setting of childhood malignancy is a frequent reason for consultation to pediatric and adolescent gynecology services. This bleeding is commonly attributed to thrombocytopenia due to bone marrow suppressive chemotherapeutic agents. However, as shown in this report, abnormal uterine bleeding might be a manifestation of an extramedullary relapse.
authors.affiliation: Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Diana T
authors.initials: DT
authors.lastname: Robillard
authors.affiliation: Division of Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Kutny
authors.affiliation: Division of Hematology/Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama; Pediatric Blood and Marrow Transplant Program, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Chewning
authors.affiliation: Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: jarbuckle@uabmc.edu.
authors.forename: Janeen L
authors.initials: JL
authors.lastname: Arbuckle
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000473:pathology / Q000628:therapy; D012008:Recurrence; D014592:Uterine Hemorrhage / Q000209:etiology*; D014594:Uterine Neoplasms / Q000473:pathology*; D014599:Uterus / Q000473:pathology*
chemical_list: D000970:Antineoplastic Agents
keywords: Abnormal uterine bleeding; Acute lymphoblastic leukemia; Adolescent; Extramedullary relapse