Vulvovaginal myeloid sarcoma with massive pelvic floor infiltration: A case report and review of literature

Table 1 Literature review and clinical data analysis

Ref.	Age (yr)	Symptom	Past history	Immunophenotype (+)	Location	Maximum diameter (cm)	Imaging examination	Lymphadenopathy	Type (FAB classification)	Treatment	Follow-up
Kamble et al[15], 1997	33	Hypermenorrhea, pain and fever	NS	NS	The vagina fornix and the cervix	7.0	US: A hypoechoic mass extending posteriorly to the vagina and bilateral dilated lower end of ureter.	NS	M2	Symptomatic treatment	Died (renal failure and fungaemia)
Unterweger et al[12], 2002	30	Vaginal bleeding, vaginal mass and fatigue	NS	MPO, lysozyme, CEA	The vaginal fornix and the cervix	5.0	MRI: A large tumor on the anterior vaginal wall extending to the cervix, suspected infiltration of the urinary bladder; CT: A homogeneous tumor appears in the the vagina, cannot be separated from the cervix; US: A homogeneous, predominantly solid space requirement of the anterior vaginal wall	The mediastinal LN	M5	Chemo	CR
Imagawa et al[6], 2010	25	Stinking vaginal discharge	NS	Lysozyme, CD68, CD34	The rectovaginal septum and the vaginal cavity	7.9	MRI: A large solitary tumor located in the vagina; PET/CT: The vaginal tumor demonstrated an increased FDG uptake with a SUV of 7.6	NS	M2	Chemo	CR, 3 y
Skeete et al[7],2010	77	Vaginal mass, urinary incontinence and fatigue	No	MPO, CD68, CD43, CD45	The vaginal wall	NS	CT: A mass involving the vagina extending to the cervix with thickening of the vaginal wall	No	Isolated MS	Chemo, RT	Died (condition deteriorated and dyspnea)
Qiang et al[14], 2010	52	Vaginal mass	Isolated MS in the cervix reached CR with chemo and hysterectomy 11 yr ago	MPO, CD117	The vaginal stump	8.0	MRI: A pear-shaped homogeneous mass arising from the vaginal stump	NS	Isolated MS	Chemo	Died (sepsis)
Nazer et al[8], 2012	41	Vaginal mass	AML (M5) reached CR 10 mo ago	MPO, CD117, CD43	The vulva, the vaginal and adjacent cervix	NS	MRI: Intermediate signal intensity mass surrounding the vagina, cervix and urethra with intact fibrous stromal tissue, invading the parametrium with involvement of the labia minora.	NS	Isolated MS	Chemo, RT	CR, 8 mo (multiple site relapse)
Modi et al[9], 2015	68	Vaginal bleeding	No	MPO, CD117, LCA	The vaginal fornix and vaginal wall	6.0	CT: Well-defined homogenously enhancing lesion arising from the left side of the vagina, projecting into vaginal lumen	NS	Isolated MS	Chemo	Asymptomatic
Yuan et al[11], 2015	40	Vaginal bleeding and vaginal mass	No	MPO, CD68, CD117, CD34, LCA, CD38, CD79a	The vulva, the vagina and the cervix	9.0	PET-CT: A soft tissue mass in the vulva, vagina, and cervix, with irregular shape, unclear border, and with a SUV of 2.4	The left inguinal region LN	Isolated MS	Chemo (only one cycle)	Died
Madabhavi et al[10], 2016	38	Vaginal bleeding	No	MPO, CD117, LCA	The vaginal fornix	5.0	CT: A mass lesion located in the vagina, mild hepatomegaly, and splenomegaly	The supra and infra diaphragmatic LN	Isolated MS	Chemo, RT	Asymptomatic
Hu et al[13], 2016	45	Vaginal mass and anuria	HSCT for MDS 7 yr ago	Lysozyme, CD117, CD34, CD56	The vulva, bilateral adnexae and bilateral perirenal spaces	2.5	US: bilateral hydronephrosis with a nondistended bladder; CT/MRI: multiple tumours in the bilateral perirenal spaces and bilateral adnexae with encasement of bilateral ureters	NS	M5	Chemo	Died
Present case	26	Vaginal bleeding and vaginal mass	No	CD99, CD68, CD15, LAC	The vulva, the vagina and massive infiltration of the pelvic floor	10.5	MRI: Ill-defined, irregular, diffuse mass with involvement of the vagina, paravaginal tissue, the urethra, posterior wall of the bladder, the left ischiorectal fossa, the left side of the pelvic diaphragm and the pelvic floor	The bilateral obturator LN	M2	Chemo, HSCT	CR
Erşahin et al[17], 2007	73	Vulval swelling and stinking vaginal discharge	Breast lesion since 3-6 yr ago	CD9, CD13, CD15, CD33, HLA-DR	The vulva	6.0	NS	NS	M2	Chemo	Died (breast cancer with multiple metastases)
Skeete et al[7], 2010	36	Vaginal mass	AML recurred repeatedly since 8 yr ago	CD68	The vagina and the rectovaginal septum	A large mass	NS	No	AML without subtype	Chemo, RT	Died (leukemic relapse)
Policarpio-Nicolas et al[16], 2012	16	Vaginal mass	No	Lysozyme, CD117, CD68, CD43, CD34, CD45RB, CD56, tdt	The vulva	2.0	NS	The left inguinal LN	Isolated MS	Chemo	CR, 11 mo
Bao et al[5], 2019	53	Vaginal bleeding and vaginal mass	Uterine fibroids	Lysozyme, CD68, CD43, CD45, CD4, CD163, CD56	The vagina	8.0	NS	NS	Isolated MS	Hysterectomy and resection of vaginal mass, chemo, HSCT	CR
Zhang et al[1],2019	47	Vaginal ulceration and fever	No	MPO, lysozyme, CD68, CD43, CD38, CD117, Ki-67	The valva	NS	NS	NS	M2	Chemo, HSCT	CR, 27 mo

TdT: Terminal deoxynucleotidyl transferase; SUV: Standard uptake value; CR: Complete remission; RT: Radiotherapy; LN: Lymph node; NS: Not stated.