Primary ovarian granulocytic sarcoma: A case report and literature review.

Abstract

e17011 Background: Granulocytic sarcoma, also known as myeloid sarcoma, myeloblastoma, and Chloroma are extramedullary manifestation of malignant myeloid precursor cells. Its occurrence as a primary ovarian tumor is a rare entity. Methods: A 49 y/o female presented to the clinic with right lower quadrant abdominal pain that had been present for 6 months. Eventually, a CT scan was obtained that showed a 6.5 cm mixed solid and cystic mass on the right adnexa that was felt to represent malignancy. Her history was positive for residing near a car-spraying garage. She was taken to the operating room and underwent a robotically assisted laparoscopic BSO, laparotomy, omentectomy, lymph node dissection and tumor debulking. Findings at surgery included a normal left ovary, adherent right ovary, normal omentum, nodular epiploicae, and tumor encasing the iliac vessels. Final pathology report of tumor cells showed granulocytic sarcoma with flow cytometry positive for CD 33 and CD 34. Bone marrow biopsy and peripheral blood flow cytometry was negative for leukemia. She subsequently underwent chemo-induction with cytarabine, idurubicin, and prednisone. Results: A PUBMED, MEDLINE/OVID database search revealed only three previously reported cases of primary ovarian granulocytic sarcoma without concurrent or subsequent hematological manifestation. Conclusions: Granulocytic sarcoma most frequently precedes or occurs in the setting of acute myeloid leukemia (AML), chronic myelogenous leukemia (CML) or myelodysplastic syndrome (MDS). The typical sites of isolated granulocytic sarcoma include bone, periosteum, soft tissues, and lymph nodes, and less commonly the orbit, intestine, mediastinum, epidural region, uterus, and ovary. In patients presenting with primary ovarian granulocytic sarcoma, the final diagnosis is obtained after tissue examination and often comes as a surprise to providers. Granulocytic sarcoma should therefore be included in the differential diagnosis of patients with isolated ovarian tumor.