Rare primary bilateral ovarian myeloid sarcoma preceding acute myeloid leukemia: Ovarian-sparing management with long-term ovarian function and pregnancy after allogeneic hematopoietic stem cell transplantation—a case report

ABSTRACT Myeloid sarcoma is a rare extramedullary manifestation of acute myeloid leukemia (AML) that may mimic benign gynecologic disease and delay diagnosis. Ovarian involvement is particularly uncommon, with bilateral disease rarely reported. We describe a 24-year-old nulliparous woman presenting with dysmenorrhea, chronic pelvic pain and bilateral adnexal masses suggestive of endometrioma on ultrasonography. Laparoscopy demonstrated bilaterally enlarged predominantly solid ovaries inconsistent with the preoperative diagnosis. Fertility-conserving surgery with unilateral salpingo-oophorectomy and contralateral ovarian conservation was performed because of the patient’s young age, reproductive goals and uncertain diagnosis. Histopathology and immunohistochemistry confirmed myeloid sarcoma with variable membranous positive for CD45 and strong positivity for myeloperoxidase, and CD117. Initial peripheral blood smear was normal; however, AML with t(8;21) and RUNX1–RUNX1T1 fusion developed 50 days later. The patient subsequently underwent cytarabine-based chemotherapy followed by allogeneic hematopoietic stem cell transplantation. At 60-month follow-up, she remains in complete remission with restoration of ovarian function, evidenced by regular menstrual cycles and normal anti-Müllerian hormone levels. She subsequently underwent in vitro fertilization using her own eggs and successfully conceived. This case highlights the diagnostic limitations of imaging for atypical ovarian masses, the importance of intraoperative reassessment, and that individualized fertility-conserving management may achieve favorable oncologic and reproductive outcomes in selected young women.