Treatment of Primary Granulocytic Sarcoma of the Uterine Cervix: Reports of Three Cases

Granulocytic sarcoma is a rare event with a poor prognosis which may herald, accompany or signal acute myeloid leukaemia. While many advances in diagnosis have been made, dilemmas remain concerning the diagnosis and treatment of this disease particularly when it arises in an unusual site such as the uterine cervix.

We describe here three female cases of primary granulocytic sarcoma in the cervix uteri who were 39, 44 and 41 years old, respectively. All the patients presented with irregular vaginal discharge or bleeding and postcoital pain. Biopsy of the vaginal wall or cervix was performed and multiple immunohostochemical analyses were obtained. Myeloid markers were strongly positive whereas lymphoid markers, epithelial markers as well as neuroendocrine markers were all negative, which confirmed the diagnosis of granulocytic sarcoma. The induction chemotherapy including homoharringtonine in combination with cytarabine (homoharringtonine, days 1–3; cytarabine days 1–7) or idarubicin with cytarabine (idarubicin, days 1–3; cytarabine days 1–7) was given followed by consolidation therapy. All the patients achieved complete remission after induction and two of whom remain in complete remission with normal complete blood counts, physical examination, abdominal ultrasonography and magnetic resonance imaging. One patient relapsed locally after six cycles of chemotherapy and progressed to acute myeloid leukemia after one year follow-up.

Granulocytic sarcoma of the cervix is a rare entity and even in its localized form, early intensive therapy appears to be appropriate. Although this experience is confirmed to three patients, it may contribute to the design of prospective therapeutic studies in patients with this rare disease.

No relevant conflicts of interest to declare.