Preleukemic granulocytic sarcoma of cervix and vagina: initial manifestation by cytology

Granulocytic sarcoma is an unusual form of tumefaction caused by acute granulocytic leukemia. On rare occasions, the lesion precedes the leukemic phase and presents as a mass with a normal peripheral white cell count. This report describes the initial manifestation of granulocytic sarcoma by vaginal cytology in a 39-year-old female with Down's syndrome. Six days after admission, the patient died of acute peritonitis following spontaneous perforation of the bowel. Autopsy revealed involvement of cervix, vagina, bowel wall and one pelvic lymph node by granulocytic sarcoma. Bone marrow examination confirmed the preleukemic stage of the disease. Cytologically, the malignant cells occurred singly. No nucleoli were seen. The differential diagnosis between malignant lymphoma and granulocytic sarcoma rests upon a positive naphtol AS-D chloroacetate esterase stain in granulocytic sarcoma. This stain may be performed on paraffin-embedded sections or on smears.