J Yeungnam Med Sci.  2023 Nov;40(Suppl):S87-S92. 10.12701/jyms.2023.00108.

Primary diffuse large B-cell lymphoma of the vulva: a case report

• Kim SY
• Koo JH
• Lee J
• Koo YJ
• Gu MJ
• Lee DH

• KMID: 2548347
• DOI: http://doi.org/10.12701/jyms.2023.00108

Abstract

Diffuse large B-cell lymphoma (DLBCL) is a subtype of non-Hodgkin lymphoma (NHL) and is estimated to account for approximately 30% of all NHL cases. NHL can also occur in the female genital tract and accounts for approximately 1.5% of all NHL cases. Many doctors have difficulty diagnosing or treating vulvar DLBCL because of its very low prevalence. A 55-year-old woman presented with a solid mass on the right side of the vulva. No significantly enlarged lymph nodes were observed in the inguinal region. She underwent excisional biopsy at our institution. DLBCL was diagnosed based on histological examination. According to the Hans algorithm, the lesion was diagnosed as a non-germinal center B-cell-like subtype. The patient was referred to a hematologic oncologist. The disease stage was classified as IE according to the Ann Arbor staging classification. The patient received four cycles of chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone and localized radiation therapy with 36 Gy in 20 fractions. She showed complete remission and maintained this status on the latest computed tomography scan. Gynecologists should rule out lymphoma in patients presenting with a vulvar mass.

Keyword

Diffuse large B-cell lymphoma; Non-Hodgkin lymphoma; Vulva

Figure

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  Fig. 1. Magnetic resonance images show an approximately 3.3 cm, well-defined, round soft tissue mass in the subcutaneous fat layer of the right vulva (arrows). (A) Axial fat-saturated T1-weighted and (B) T2-weighted images show homogeneous iso-signal intensity of the mass with a central focal curvilinear fluid-equivalent signal intensity lesion. (C) Contrast-enhanced axial and (D) sagittal fat-saturated T1-weighted images demonstrate homogeneous, mild enhancement of the mass with surrounding subcutaneous swelling and enhancement. The intralesional focal curvilinear lesion shows strong enhancement.

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  Fig. 2. Histopathologic findings of the vulva mass. (A) The lymphoid cells are diffusely infiltrated (hematoxylin and eosin stain, x40). (B) Medium-to-large-sized lymphoid cells are present (hematoxylin and eosin stain, x200). (C) The tumor cells are strongly positive for CD79a (immunohistochemical stain, x200). (D) The tumor cells are negative for CD3 (immunohistochemical stain, x200).

Reference

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