CHARACTERISTIC OF MYELOID SARCOMA BY CANCER GENOME PROFILING AND ALGORITHM OF POTENTIAL BIOMARKERS FOR UTERINE MESENCHYMAL TUMOR.

BACKGROUND: The patient experienced irregular bleeding and menstrual cycles and was receiving medical treatment and follow-up at a nearby women's clinic. However, the patient complained of vulvar discomfort; therefore, magnetic resonance imaging (MRI) was performed to investigate the cause. Imaging revealed a cervical mass, and the patient was referred to the Obstetrics and Gynecology Department of our general hospital. During the outpatient examination, our gynecologic staff noted significant swelling of the cervical lips. Furthermore, although the blood test results did not reveal any obviously high levels of tumor markers, the concentration of soluble interleukin-2 receptor (sIL-2R) was high at 4650 (U/mL). Therefore, pathological examination using a cervical biopsy was performed, and cervical sarcoma was suspected. Cervical carcinosarcoma or sarcoma is a rare tumor classified as an epithelial-mesenchymal mixed tumor. No established standard treatment exists for this tumor, and it has a poor prognosis. Contrast-enhanced computed tomography (CT) imaging and contrast-enhanced MRI were performed, and no obvious metastatic lesions were observed.

METHODS: A surgical treatment plan was established, and modified radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed. To make a definitive diagnosis, surgical pathology was performed using surgically removed tissue and a diagnostic algorithm specific for uterine leiomyosarcoma.

RESULT: Enlarged lymph nodes were observed, indicating pelvic lymph node metastasis. Based on the algorithm for uterine mesenchymal tumors established by the authors and the results of the surgical pathology examination of the tissue resected by surgical treatment, the patient's tumor was diagnosed as a myeloid sarcoma. Since the oncological properties of myeloid sarcoma are similar to those of acute myeloid leukemia (AML), the concentration of sIL-2R is elevated. Currently, treatment is the same as that for AML, consisting of induction therapy (daunorubicin + cytarabine) and consolidation therapy (high-dose cytarabine). To date, no recurrence of myeloid sarcoma was noted, and the patient is doing well.

CONCLUSION: In cancer treatment, contrast-enhanced MRI is useful for identifying the size and location of tumor masses. However, contrast-enhanced MRI does not lead to the diagnosis of tumor masses. Therefore, early blood tests and tumor biopsy results are important for differential diagnosis and early treatment decisions.