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Abstract
Introduction/Background We present the case of a 46 year-old woman with a rare gynecological presentation of an aggressive lymphoma.
Methodology Case report.
Results A 46 year-old woman is referred to the hospital for presenting leucorrea and irregular copious vaginal bleeding; she denies other symptoms. At the physical examination a solid and fixed mass deforming the cervix is observed and the posterior vaginal wall appears thickened. The transvaginal ultrasound shows a solid and vascularized (colour score 4) image of 94 × 6565 mm. The MRI confirms the presence of a pelvic mass at the cervix of 10 × 9 × 10 cm with necrotic areas. Other iliac, presacral and inguinal lymphadenopathies are identified by PET scan. Hysteroscopy identifies two typical endocervical polyps and a normal endometrium. Biopsies are realized directly at the surface of the visible lesion through speculum examination. The anatomopathological analysis reveals a diffuse Large B-cell lymphoma so the patient is remitted to the Haematologist to complete the staging and start the chemo-immunotherapy.
Conclusion Hematologic malignancies rarely present as a primary gynaecologic problem and primary gynaecologic Non-Hodgkin Lymphoma are sporadically reported in the literature. Primary NHL can mimic gynaecological malignancy such as endometrial cancer, cervical cancer, sarcoma or ovarian cancer presenting as a pelvic mass. The primary site of origin for lymphomas is the lymph nodes and other lymphoid tissue but approximately 10 to 35% of patients have a primary extranodal lymphoma at the time of diagnosis. Only less than 0.5% of all extranodal NHLs involve the female genital tract. Most patients lack the classical B symptoms associated with lymphoma: fatigue, fever, night sweats and weight loss. The primary pelvic lymphomas have a five-year survival rate of 80% to 90% if the diagnosis was made early and therapy was adequate so the diagnosis of primary pelvic lymphoma should be considered in the differential diagnosis of gynaecological malignancies.
Disclosure Nothing to disclose.
MRI: a pelvic mass of the cervix (10 × 9 × 10 cm) with necrotic areas