PMC7596908_01
CT/MRI findings in the lower abdomen.. A; Horizontal section (CT), B; Sagittal section (CT), C; T1 high-intensity lesions (MRI), D; T2 high-intensity lesions (MRI), E; Apparent diffusion coefficient (ADC) (MRI), F; Gd enhancement (MRI). Asterisks and arrows indicate the uterus and uterine mass, respectively.. 1A and 1B. CT findings of extramedullary uterine relapse. The uterine lesion was not detected at the time of initial diagnosis, but was evident as a mass at the time of the second relapse.. 1C-1F. MRI findings of uterine relapse. MRI revealed a 6.8-cm uterine mass having heterogeneous high intensity (T2-WI/D-WI), marked ADC decrease (0.4 x 10(-3) mm2/s), and a mild to moderate degree of enhancement (CE study).
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CT revealed a large mass in the uterine region (Figure 1A, B), but no masses were found in other regions of the body. Furthermore, MRI revealed a heterogeneous high-intensity mass (T2-WI/D-WI) with a diameter of 6.8 cm, a notable decrease in the apparent diffusion coefficient (ADC) (0.4 x 10(-3) mm2/s), and mild enhancement by contrast enhancement study (Figure 1C-F).
Histological and immunohistochemical findings of the uterine biopsy.. A; H.E. (x100), B; CD79a (x40), C; TdT (x40). 2A-2C. Recurrence of ALL at the uterus was confirmed by biopsy. There were small aggregates of lymphoid cells with medium-sized round nuclei, some exhibiting distinct nucleoli and scant amount of cytoplasm in the endocervical mucosa. Immunohistochemically, these lymphoid cells were positive for CD79a and TdT, but negative for CD20, cCD3, CD5, CD34, and MPO. Reactive T-cells (cCD3-positive) were intermingled in the background. The Ki67-positive rate of these lymphoid cells was approximately 50%. These findings are consistent with ALL cells.
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Biopsy of the uterine cervix revealed small aggregates of atypical lymphoid cells with round nuclei, some distinct nucleoli, and scant cytoplasm in the hemorrhagic and edematous background (Figure 2A). Immunohistochemically, these lymphoid cells were positive for CD79a and TdT (Figure 2B, C), but negative for CD20, cCD3, CD5, CD34, and MPO.