AML -> Uterine Sarcoma
Patient is a 39-year old female with a past medical history of Acute Myelogenous Leukemia in remission (1.5 years) who presented to the emergency department with AKI. Workup in ED included KUB which showed bilateral nephroureteral stents in place, U/S showed worsening b/l hydronephrosis and a ‘bulky uterus’. The patient also reported intermenstrual spotting. An MRI with and without contrast was ordered to further investigate the uterine findings on ultrasound. MRI showed a diffusely enlarged uterus, new from prior imaging, suggestive of diffuse infiltrative process. Findings were non-specific but the considerations included extramedullary relapse of AML as uterine granulocytic sarcoma. A further evaluation by gynecology was recommended with consideration of biopsy. PET imaging showed significantly increased metabolic activity in particular in the cervical region and Pathology confirmed the uterine granulocytic sarcoma diagnosis with cervical biopsy. Radiation therapy was performed and post-treatment MRI and PET showed complete resolution of uterine findings.