Uterine Mass and Menorrhagia: A Rare Presentation of Acute Myeloid Leukemia with Arduous Clinical Course.

A 36-year-old multiparous lady presented with complaints of menorrhagia and fatigue for three months. There was no history of bleeding from any other site, fever, lower abdominal pain, or abdominal distension. She was diagnosed with primary hypothyroidism five years back, and since then she had regularly been on a stable thyroxine dose (125 μg per day); there was no history of any other drug intake in the past. Surgical history was noteworthy for cesarean section ten years back. She was hemodynamically stable; no pallor, goiter, or petechial spots observed on general physical examination. Systemic examination was inconspicuous. Hemogram (hemoglobin 128g/L; total leucocyte count 7.6x109/L; and platelet count 360x109/L), peripheral blood smear and coagulogram were normal. Urine for pregnancy test was negative; serum prolactin and thyrotrophin-stimulating hormone levels were normal. To rule out local genital lesion, a detailed pelvic examination (including speculum examination) was performed. The posterior lip of the cervix appeared bulky with a 2x1 cm reddish-pink, sessile, firm, nodular lesion arising from it. At this point, the possibility of cervical carcinoma versus benign cervical lesion (mucus retention cyst, ectropion, benign polyp, endometriosis, cervicitis, etc.) was considered. Brushed smear from the cervical lesion revealed high-grade dysplasia. Pelvic ultrasound revealed an illdefined heterogeneous, hypoechoic soft tissue lesion involving the cervix; there was no vaginal or parametrial involvement. A total abdominal hysterectomy was performed. Surprisingly, histologic examination of the uterus revealed infiltration of muscle bundles, consisting of sheets of atypical cells reminiscent of lymphoid cells (Figure 1a). Immunohistochemistry showed strong myeloperoxidase (MPO) positivity in the atypical cells, 1Department of Internal Medicine, Postgraduate Institute of Medical Training and Research, Chandigarh, India 2Department of Pathology, Postgraduate Institute of Medical Training and Research, Chandigarh, India 3Department of Nuclear Medicine, Postgraduate Institute of Medical Training and Research, Chandigarh, India Kundan Mishra1, Chandrasekaran Muralidaran2, Aditya Jandial1, B.R. Mittal3, Subhash Varma1 Uterine Mass and Menorrhagia: A Rare Presentation of Acute Myeloid Leukemia with Arduous Clinical Course