Unusual locations for lymphomas. Case 1. Intermediate-grade lymphoma of the cervix

The importance of re-examination with deep biopsies in diagnosing cervical malignancies despite multiple negative pathology reports: A case report

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The role of gynecological examination in diagnosis genital cancer is important as in this case (a woman with stony cervix and frozen pelvis).

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When we have frozen pelvis and fix stony cervix, taking multiple deep biopsies in spite of previous negative pathologic reports, is necessary.

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Reviewing the slides by qualified pathologists can help us to achieve true diagnosis when we the physical exam does not match with histopatologic results.

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Lymphoma should be always in our mind to remind the pathologists.

Introduction

Clinical symptoms of female genital tract lymphoma are often non-specific, and mimic other more common gynecological malignancies. Diagnosis can only be confirmed by histology.

Case presentation

We report the case of a 48-year-old multiparous woman who underwent subtotal hysterectomy because of enlarged myomatous uterus and persistent heavy vaginal bleeding. “2 months later”, postoperative pelvic and abdominal CT scan performed because of flank pain, revealed bilateral hydronephrosis. Pelvic and colposcopic exam and cervical biopsy under anesthesia showed benign histology, as reported by two pathologists. Referral to a third pathologist and immunohistochemical (IHC) exam revealed malignant lymphoproliferative disorder.

Conclusion

Despite multiple negative pathology reports of the cervical biopsies, bimanual pelvic exam with deep biopsies by a gynecologist, allowed accurate final diagnosis of this unusual case.

Primary lymphoma of the uterus and cervix: two case reports and review of the literature

Primary lymphoma of the uterus and cervix is rarely encountered. We present two cases of diffuse large B-cell lymphoma of the cervix and uterus that were treated with R-CHOP chemotherapy followed by pelvic radiotherapy. The women are disease free 20 and 19 months after the diagnosis respectively. Seventy-two cases of primary uterine and cervical lymphoma reported in the English literature in the last 10 years from 2000 to 2010 are reviewed.

Primary follicular lymphoma of the cervix uteri: a review

Primary non-Hodgkin's lymphoma of the cervix is a rare disease, of which a subgroup of follicular lymphoma constitutes only 8.5%. There is not an established treatment protocol neither for primary cervical lymphoma nor for its follicular subgroup. We presented a case with Ann Arbor stage IEA (Extra-nodal involvement and absence of weight loss, fever, night sweat) primary follicular lymphoma of the cervix. She was treated with chemotherapy followed by pelvic radiotherapy. Upon relapse with a nodal neck mass, she was treated with rituximab alone. She remained well for 23 months after rituximab. In the 39 months of follow-up, there was no evidence of disease. In the light of our case, we reviewed the reported cases of primary follicular lymphoma of the cervix while discussing their treatment protocols and the cases of primary cervix lymphoma treated with rituximab.

Primary lymphomas of the cervix and uterus: the University of Pennsylvania's experience and a review of the literature

Primary lymphomas of the cervix and uterus are rare with approximately 150 cases reported in the world literature to date. Appropriate diagnosis is often delayed until the post-operative setting as clinical and radiographic presentations are non-specific. Several sub-types of lymphoma arising primarily in the cervix or uterus have been reported with diffuse large B-Cell lymphoma (DLBCL) being the most frequent. Due to the low incidence of this disease, no randomized clinical trials exist to help guide treatment. This study reports the experience of four patients with primary lymphomas of the uterus and cervix that reflect the heterogeneity of cases reported in the literature to date. The patients had a mean age at diagnosis of 46 (range 35 - 56) and presented with abnormal uterine bleeding. One patient was diagnosed by total abdominal hysterectomy (TAH), two patients were diagnosed by cervical biopsy and one patient was diagnosed by endometrial biopsy. Three patients had DLBCL and one patient had marginal zone lymphoma (MZL). All patients had stage IIE disease. Of the patients with DLBCL, one received chemotherapy followed by TAH and two received TAH followed by chemotherapy. Two of these three patients remain disease-free post-initial therapy with the third now disease-free post-salvage therapy and autologous stem cell transplant. The patient with MZL was treated with TAH alone and remains disease-free. Based on the case series and a review of available literature, primary lymphomas of the uterus or cervix are rare and require an individualized approach to treatment. In general, patients with limited stage disease should be treated with localized and systemic therapy to optimize chances of cure.