Radiotherapy in Cervical Myeloid Sarcoma: A Case Report and Literature Discussion

Zi-Hong Li,* Jia-Xing Guo,* Ji-Hong Zhang, Zhi-Ling An, Xiao Liang, Li-Hua Wang, Ying-Na Bao Department of Radiotherapy, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010050, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ying-Na Bao, Department of Radiotherapy, The Affiliated Hospital of Inner Mongolia Medical University, 1 Tongdao North Street, Hohhot, 010050, People’s Republic of China, Tel +864713451360, Email baoyingnaq@126.comBackground: Myeloid sarcoma (MS) is a rare extramedullary tumor formed by the abnormal proliferation of immature myeloid cells. It can occur concurrently with or secondary to various myeloid neoplasms, most commonly acute myeloid leukemia (AML). Cervical involvement is extremely rare, and its clinical presentation often mimics that of primary gynecologic malignancies, typically manifesting as vaginal bleeding, a palpable cervical mass, or cervical enlargement.Case Presentation: We report the case of a 67-year-old woman with a history of AML who had received multiple lines of chemotherapy and presented with irregular vaginal bleeding since more than 1 month. Cervical biopsy showed diffuse infiltration of atypical myeloid cells, and immunohistochemistry supported the diagnosis of MS. She received pelvic radiotherapy with 6 MV X-ray intensity-modulated radiation therapy combined with intracavitary brachytherapy, and follow-up evaluation 3 months later demonstrated marked shrinkage of the cervical mass.Conclusion: This case highlights that cervical MS is prone to being misdiagnosed and that histopathology with immunohistochemistry is essential for a definitive diagnosis. Even in patients who have undergone multiple lines of systemic therapy and are unable to receive hematopoietic stem cell transplantation, local radiotherapy can achieve rapid and effective local control, and may confer a survival benefit.Keywords: myeloid sarcoma, cervical myeloid sarcoma, acute myeloid leukemia, radiotherapy, prognosis