Korean J Obstet Gynecol.  2011 Jan;54(1):57-61. 10.5468/KJOG.2011.54.1.57.

A case of primary malignant lymphoma of the uterus

• Suh MJ
• Park DC

• KMID: 2274024
• DOI: http://doi.org/10.5468/KJOG.2011.54.1.57

Abstract

Primary uterine non-Hodgkin's lymphoma is a rare malignancy and the most common histological subtype is the diffuse large B-cell lymphoma. This case is a patient underwent surgery for early gastric cancer in November 2007, and determined to be completely cured, and subsequently, during the follow up observation, in pelvic computed tomography, a uterine mass suspicious to be either uterine cervical cancer or uterine sarcoma was observed. She was transferred to department of gynecologic oncology, modified radical hysterectomy and pelvic lymph node dissection were performed. Histologically the uterine mass was diagnosed as diffuse large B-cell lymphoma. Currently she is received the rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone chemotherapy. Thus we report the case with a brief review of the literature. Primary malignant lymphoma in the uterus is very rare, and its diagnosis as well as treatments has not been established. Therefore, in the future, through continuous clinical discussion on this disease, a guideline for the diagnosis and treatment for primary uterine lymphoma should be established.

Keyword

Lymphoma; Uterine cancer

MeSH Terms

Antibodies, Monoclonal, Murine-Derived
Cyclophosphamide
Doxorubicin
Follow-Up Studies
Humans
Hysterectomy
Lymph Node Excision
Lymphoma
Lymphoma, B-Cell
Lymphoma, Non-Hodgkin
Prednisone
Sarcoma
Stomach Neoplasms
Uterine Cervical Neoplasms
Uterine Neoplasms
Uterus
Vincristine
Rituximab
Antibodies, Monoclonal, Murine-Derived
Cyclophosphamide
Doxorubicin
Prednisone
Vincristine

Figure

• 

  Fig. 1 Pelvic computed tomography. they show that the about 7.6×6.5 sized lobulated, heterogenous contrast enhancing mass in around uterine cervix (arrow).

• 

  Fig. 2 Positron emission tomography-computed tomography (PET-CT). Whole body PET-CT shows an about 8.5 cm sized mass with increased F-18 fluorodeoxyglucose uptake at cervix and upper vagina, suggesting rapid growing atypical uterine cervical cancer or sarcoma (arrow).

• 

  Fig. 3 (A) On low magnification, the architecture is replaced by neoplastic process with a diffuse growth pattern (H&E, ×100). (B) On high magnification, the tumor cells have large nuclei with dispersed chromatin, small nucleoli, and a variable amount of cytoplasm (H&E, ×400). (C) CD20 demonstrates positive staining in the cytoplasm of tumor cells (Immune stain for CD20, ×400). (D) CD3 demonstrates negative staining in the cytoplasm of tumor cells (immune stain for CD3, ×400).

Reference

1. Freeman C, Berg JW, Cutler SJ. Occurrence and prognosis of extranodal lymphomas. Cancer. 1972. 29:252–260.

2. Stroh EL, Besa PC, Cox JD, Fuller LM, Cabanillas FF. Treatment of patients with lymphomas of the uterus or cervix with combination chemotherapy and radiation therapy. Cancer. 1995. 75:2392–2399.

3. Polednak AP. Trends in cancer incidence in Connecticut. Conn Med. 1997. 61:211–218.

4. Harris NL. Jaffe EJ, Harris NL, Stein H, editors. Mature B-cell neoplasm. WHO classification of tumours: pathology and genetics of tumours of haematopoietic and lymphoid tissues. 2001. Lyon (FR): IARC Press;121–126.

5. Chorlton I, Karnei RF Jr, King FM, Norris HJ. Primary malignant reticuloendothelial disease involving the vagina, cervix, and corpus uteri. Obstet Gynecol. 1974. 44:735–748.

6. Kuo HC, Chou CY, Chang CH, Liu MT, Tzeng CC, Huang KE. Primary malignant lymphoma of the uterine cervix shows favorable response to neoadjuvant chemotherapy. Gynecol Oncol. 1994. 52:408–410.

7. Wilson JD, Braunwald E, Isselbacher KJ, Petersdorf RG, Martin JB, Fauci AS, et al. Harrison's principles of internal medicine. 1991. 12th ed. New York (YK): McGraw-Hill.

8. Dursun P, Gultekin M, Bozdag G, Usubutun A, Uner A, Celik NY, et al. Primary cervical lymphoma: report of two cases and review of the literature. Gynecol Oncol. 2005. 98:484–489.

9. Szantho A, Balega JJ, Csapo Z, Sreter LL, Matolcsy A, Papp Z. Primary non-Hodgkin's lymphoma of the uterine cervix successfully treated by neoadjuvant chemotherapy: case report. Gynecol Oncol. 2003. 89:171–174.

10. Chan JK, Loizzi V, Magistris A, Hunter MI, Rutgers J, DiSaia PJ, et al. Clinicopathologic features of six cases of primary cervical lymphoma. Am J Obstet Gynecol. 2005. 193:866–872.

11. Boye J, Elter T, Engert A. An overview of the current clinical use of the anti-CD20 monoclonal antibody rituximab. Ann Oncol. 2003. 14:520–535.

12. Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002. 346:235–242.