Janeen L. Arbuckle

Extramedullary Relapse of Acute Lymphoblastic Leukemia Presenting as Abnormal Uterine Bleeding: A Case Report

BACKGROUND Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Relapse of ALL occurs in 15%-20% of patients, with 2%-6% occurring exclusively in extramedullary sites. Relapse of ALL in gynecologic organs is extremely rare. CASE We present a case of a 12-year-old girl with a history of ALL who was referred to the pediatric gynecology clinic with abnormal uterine bleeding. She was determined to have an extramedullary uterine relapse of her ALL. SUMMARY AND CONCLUSION Abnormal uterine bleeding in the setting of childhood malignancy is a frequent reason for consultation to pediatric and adolescent gynecology services. This bleeding is commonly attributed to thrombocytopenia due to bone marrow suppressive chemotherapeutic agents. However, as shown in this report, abnormal uterine bleeding might be a manifestation of an extramedullary relapse.

Advanced Imaging for the Diagnosis and Treatment of Coexistent Renal and Müllerian Abnormalities

Purpose of ReviewAbnormal development of the uterus, cervix, and proximal 2/3 of the vagina results in Müllerian duct anomalies. Because of the close embryologic relationship between the developing female genital and urinary tracts, abnormalities of the urinary tract often accompany Müllerian duct anomalies. Magnetic resonance imaging (MRI) is the current gold standard-imaging modality in the evaluation of the anomalies of the female reproductive tract. This article discusses the imaging evaluation of Müllerian duct and accompanying urinary tract anomalies with a particular focus on the MRI findings.Recent FindingsSeveral studies have shown high concordance between MRI and three-dimensional ultrasound (3D US) in the evaluation of Müllerian duct abnormalities. 3D US is more cost effective than MRI but has not yet been fully substantiated as a comparable modality to MRI. Additionally, 3D US does not help elucidate concomitant anomalies of the urologic system.SummaryMüllerian duct anomalies are often associated with abnormalities of the urinary tract. Evaluation with MRI is important for the diagnosis of Müllerian duct anomalies and also helps with potential surgical planning.

Development of the Female Reproductive Tract and Associated Anomalies

Opinion statementAberrations in the development of the female reproductive tract result in an array of anomalies. Because of the wide range of possible anomalies, the presentation of women with congenital anomalies of the reproductive tract is highly variable. While some women are asymptomatic, others present with symptoms of pain, menstrual abnormality, recurrent pregnancy loss, and/or poor obstetric outcomes. When providing care for patients with anomalies of the female reproductive tract, it is critical to be sensitive to both the patient’s physical and psychological well-being. When an intervention is indicated, patient maturity, motivation, and ability to be an active participant in their care should be considered. Due to the rarity of some of the anomalies of the female reproductive tract, care at a center with special expertise in the care of these complex patients is at times warranted.

Anovulatory Bleeding in a 12-Year-Old as Presenting Sign for Rare Undifferentiated Sarcoma

BACKGROUND Abnormal uterine bleeding is a common phenomenon in perimenarchal females. Though most cases of abnormal bleeding are due to anovulatory bleeding or bleeding disorders, rare cases are attributable to underlying malignancy. CASE Here we report a 12-year-old female patient who presented with abnormal uterine bleeding three months after menarche. She was ultimately diagnosed with a pelvic sarcoma of unknown primary origin. She was subsequently treated with chemotherapy, whole pelvic radiation, and hysterectomy with bilateral salpingo-oophorectomy. SUMMARY Abnormal uterine bleeding unresponsive to conventional temporizing measures should be thoroughly evaluated. Management of pelvic malignancies in the pediatric population requires cooperation amongst specialists from an array of disciplines.