Letter to the Editor—Brief Communication / European Journal of Obstetrics & Gynecology and Reproductive Biology 184 (2015) 125–131
126
Amerigo Vitagliano Marco Noventa Salvatore Gizzo* Department of Woman and Child Health, University of Padua, Padua, Italy *Corresponding author at: Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, Via Giustiniani 3, 35128 Padova, Italy. Tel.: +39 333 5727248/049 8213400; fax: +39 049 8211785 E-mail address: [email protected] (S. Gizzo). Received 31 October 2014
http://dx.doi.org/10.1016/j.ejogrb.2014.11.018
Chronic lymphocytic leukemia of the genital tract Dear Editors, We report on an 82-year-old woman, known to have chronic lymphocytic leukemia (CLL), who presented with post-menopausal bleeding. Mrs. R.H. is an 82-year-old, Gravida 8, Para 7, postmenopausal for 30 years, female, who presented to our clinic with postmenopausal bleeding of one week duration. Patient was known to have CLL of six years duration; however, she was asymptomatic and on no medical treatment. Evaluation revealed an unremarkable general examination with no localized palpable adenopathy or hepatosplenomegaly. Pelvic examination showed an upper vaginal flat irregularity with no conspicuous lesion. The cervix had the same appearance. Bimanual examination revealed an irregular upper vagina and a relatively hard cervix and a small unremarkable uterus with free adnexa. Transvaginal ultrasonography revealed a bright 12-mm thick endometrium. Cervical cytological smear revealed abundant lymphocytes. Biopsies of the upper vagina, cervix, and endometrium were all consistent with CLL (Fig. 1). The vaginal bleeding subsided spontaneously and since then the patient has had no more bleeding and is doing well on no medical treatment.
Chronic lymphocytic leukemia (CLL) is one of the most common adult leukemias (1). It usually affects the older population and is associated with an increase and accumulation of small matureappearing B-lymphocytes in multiple areas of the body including the blood stream, the bone marrow, and the lymphoid tissues [1]. However, CLL is commonly asymptomatic and incidentally discovered during a routine complete blood count that shows absolute lymphocytosis [1]. Most symptomatic patients usually complain of generalized fatigue, malaise, progressive weight loss, recurrent infections, fever, and night sweating [1]. In 1956, three women were diagnosed to have leukemia after presenting with vaginal bleeding [2]. However, none of these women had CLL. Post-mortem examination of patients with leukemia shows that eight out ten patients have leukemic infiltration of their female genitalia, however, only one in 10 of those patients is found to have CLL [2]. In addition, infiltration of the uterus at autopsy in advanced leukemia was reported in 14% of 109 patients with CLL [3]. Involvement of the internal genital tract with CLL has been rarely reported in the form of abnormal cytology and/or colposcopy, with or without localized gynecologic symptoms [4]. In some cases, these findings led to the diagnosis of CLL [4,5] while it indicated disseminated disease in other cases of known CLL [5]. To note, involvement of the vulva is not uncommon, as cutaneous involvement of CLL is well-known [1]. Our patient had involvement of the internal genital tract from vagina to the cervix and the endometrium, a finding not previously reported in the literature. Since our patient had spontaneous remission of her bleeding and in view of the lack of any other indication to treat CLL, such as splenomegaly, symptomatic lymphadenopathy, autoimmune cytopenias, or progressive lymphocytosis, she was observed closely with regular follow ups, necessitating no medical treatment up to this date [1]. References [1] Yee KW, O’Brien SM. Chronic lymphocytic leukemia: diagnosis and treatment. Mayo Clin Proc 2006;81(8):1105–29. [2] Israel SL, Mutch JC. Leukemic infiltration of female genitalia; a gynecologic entity. Obstet Gynecol 1956;7(4):425–32. [3] Barcos M, Lane W, Gomez GA, et al. An autopsy study of 1206 acute and chronic leukemias (1958 to 1982). Cancer 1987;60(4):827–37. [4] Hauptman HTF. Leucemic infiltration of the female internal genitalia as a cause of vaginal bleeding. Am J Obstet Gynecol 1940;39:70–7. [5] Stein L. Chronic lymphatic leukaemia presenting as neoplasm of the cervix uteri. J Obstet Gynaecol Br Emp 1949;56(1):107.
Talal Seoud Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon Muhieddine Seoud Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon Antoine Saliba Ali Taher* Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon *Corresponding author at: Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon E-mail address: [email protected] (A. Taher).
Fig. 1. Microscopic appearance of chronic lymphocytic leukemia of the cervix. Arrow points to the lymphocytic infiltration.
14 October 2014 http://dx.doi.org/10.1016/j.ejogrb.2014.11.017
126
Amerigo Vitagliano Marco Noventa Salvatore Gizzo* Department of Woman and Child Health, University of Padua, Padua, Italy *Corresponding author at: Dipartimento di Salute della Donna e del Bambino, U.O.C. di Ginecologia e Ostetricia, Via Giustiniani 3, 35128 Padova, Italy. Tel.: +39 333 5727248/049 8213400; fax: +39 049 8211785 E-mail address: [email protected] (S. Gizzo). Received 31 October 2014
http://dx.doi.org/10.1016/j.ejogrb.2014.11.018
Chronic lymphocytic leukemia of the genital tract Dear Editors, We report on an 82-year-old woman, known to have chronic lymphocytic leukemia (CLL), who presented with post-menopausal bleeding. Mrs. R.H. is an 82-year-old, Gravida 8, Para 7, postmenopausal for 30 years, female, who presented to our clinic with postmenopausal bleeding of one week duration. Patient was known to have CLL of six years duration; however, she was asymptomatic and on no medical treatment. Evaluation revealed an unremarkable general examination with no localized palpable adenopathy or hepatosplenomegaly. Pelvic examination showed an upper vaginal flat irregularity with no conspicuous lesion. The cervix had the same appearance. Bimanual examination revealed an irregular upper vagina and a relatively hard cervix and a small unremarkable uterus with free adnexa. Transvaginal ultrasonography revealed a bright 12-mm thick endometrium. Cervical cytological smear revealed abundant lymphocytes. Biopsies of the upper vagina, cervix, and endometrium were all consistent with CLL (Fig. 1). The vaginal bleeding subsided spontaneously and since then the patient has had no more bleeding and is doing well on no medical treatment.
Chronic lymphocytic leukemia (CLL) is one of the most common adult leukemias (1). It usually affects the older population and is associated with an increase and accumulation of small matureappearing B-lymphocytes in multiple areas of the body including the blood stream, the bone marrow, and the lymphoid tissues [1]. However, CLL is commonly asymptomatic and incidentally discovered during a routine complete blood count that shows absolute lymphocytosis [1]. Most symptomatic patients usually complain of generalized fatigue, malaise, progressive weight loss, recurrent infections, fever, and night sweating [1]. In 1956, three women were diagnosed to have leukemia after presenting with vaginal bleeding [2]. However, none of these women had CLL. Post-mortem examination of patients with leukemia shows that eight out ten patients have leukemic infiltration of their female genitalia, however, only one in 10 of those patients is found to have CLL [2]. In addition, infiltration of the uterus at autopsy in advanced leukemia was reported in 14% of 109 patients with CLL [3]. Involvement of the internal genital tract with CLL has been rarely reported in the form of abnormal cytology and/or colposcopy, with or without localized gynecologic symptoms [4]. In some cases, these findings led to the diagnosis of CLL [4,5] while it indicated disseminated disease in other cases of known CLL [5]. To note, involvement of the vulva is not uncommon, as cutaneous involvement of CLL is well-known [1]. Our patient had involvement of the internal genital tract from vagina to the cervix and the endometrium, a finding not previously reported in the literature. Since our patient had spontaneous remission of her bleeding and in view of the lack of any other indication to treat CLL, such as splenomegaly, symptomatic lymphadenopathy, autoimmune cytopenias, or progressive lymphocytosis, she was observed closely with regular follow ups, necessitating no medical treatment up to this date [1]. References [1] Yee KW, O’Brien SM. Chronic lymphocytic leukemia: diagnosis and treatment. Mayo Clin Proc 2006;81(8):1105–29. [2] Israel SL, Mutch JC. Leukemic infiltration of female genitalia; a gynecologic entity. Obstet Gynecol 1956;7(4):425–32. [3] Barcos M, Lane W, Gomez GA, et al. An autopsy study of 1206 acute and chronic leukemias (1958 to 1982). Cancer 1987;60(4):827–37. [4] Hauptman HTF. Leucemic infiltration of the female internal genitalia as a cause of vaginal bleeding. Am J Obstet Gynecol 1940;39:70–7. [5] Stein L. Chronic lymphatic leukaemia presenting as neoplasm of the cervix uteri. J Obstet Gynaecol Br Emp 1949;56(1):107.
Talal Seoud Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon Muhieddine Seoud Gynecologic Oncology, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon Antoine Saliba Ali Taher* Hematology/Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon *Corresponding author at: Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Cairo Street, Beirut, Lebanon E-mail address: [email protected] (A. Taher).
Fig. 1. Microscopic appearance of chronic lymphocytic leukemia of the cervix. Arrow points to the lymphocytic infiltration.
14 October 2014 http://dx.doi.org/10.1016/j.ejogrb.2014.11.017
