Case of extranodal non-hodgkins lymphoma involving the endometrium and the ovaries: a rare case report

Authors

  • Lakshmi Manjeera Malempati Department of Obstetrics and Gynecology, K. S. Hegde Medical College, NITTE University, Mangalore, Karnataka, India
  • Neetha Nandan Department of Obstetrics and Gynecology, K. S. Hegde Medical College, NITTE University, Mangalore, Karnataka, India
  • Sagarika Babu Department of Obstetrics and Gynecology, K. S. Hegde Medical College, NITTE University, Mangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20174076

Keywords:

Diffuse large B cell lymphoma, Extra nodal lymphoma, Female genital tract, R-CHOP, Non-Hodgkin’s lymphoma

Abstract

Non-Hodgkin’s lymphoma(NHL) is most commonly encountered during childhood and rarely among the adults. Primary malignant lymphoma in the female genital tract are rare Moreover they present with non-specific symptoms and hence there may be delay in the diagnosis. It is difficult to distinguish this condition from the more common uterine neoplasm such as uterine fibroids or sarcoma. Diffuse large B-cell lymphoma (DLBCL) is most commonly seen among the cases of NHL, contributing to among one third of NHL in the western world. DLBCL is common in elderly population. A 69-year-old postmenopausal woman who came with watery discharge since, 15 days was evaluated clinically and radiologically and was found to have thickened endometrium and enlarged ovaries, for which endometrial biopsy was taken that showed non-secretory endometrium with atrophic changes. Tumor markers found to be normal. TAH+BSO was done and the histopathology showed Non-Hodgkin’s lymphoma, diffuse large B cell type of the endometrium and both ovaries which was confirmed by immune histochemical marker study. PET-CT was done that showed metabolically active para aortic and common iliac lymph nodes thereby she was diagnosed with stage II (Ann Arbor Staging) non-Hodgkin’s lymphoma, hence she received 6 cycles of R-CHOP. As evident in our case, non-Hodgkin’s Lymphoma of the endometrium and the ovaries being an extremely rare condition, high-degree of suspicion is required for its prompt diagnosis and treatment.

References

Doren M, Schneider HPG, Holzgreve W. Sonographic manifestation of non-Hodgkin’s lymphoma invading the postmenopausal endometrium. Ultra Obstet Gynecol. 1995;6:300-1.

Tatishchev S, Lee A, Natural R, Romero JY, Dewar R. Primary diffuse large B-cell lymphoma of the uterus manifesting as a leiomyoma: A unique presentation with review of literature. J Krishna Inst Med Sci Univ. 2013;2:109-16.

Srivastava P, Ahluwalia C, Zaheer S, Mandal AK. Primary non-Hodgkin’s lymphoma of the female genital tract in a 27-year-old female: A rare case report. Clin Cancer Investig J. 2016;5:287-90.

Kaur N, Kaushik R, Gulati A, Kaushal V, Chahal JS. Non-Hodgkin's lymphoma presenting as an ovarian mass. Clin Cancer Investig J. 2014;3:231-4.

Yamamoto Y, Chaki O, Nakayama M. Two Cases of NonHodgkin’s Lymphoma Involving the Uterus. Gynecol Obstet (Sunnyvale). 2014;4:213.

Vang R, Medeiros LJ, Ha CS, Deavers M. Non-Hodgkin's lymphomas involving the uterus: A clinicopathologic analysis of 26 cases. Mod Pathol. 2000;13:19-28.

Shen CJ, Tsai EM, Tsai KB, Wu CH, Hsu SC. Primary T-cell lymphoma of the uterine corpus. Kaohsiung J Med Sci. 2007;23:138-41.

Jeong D, Jeong Y, Jeon S, Cho HD, Bae DH, Kim CJ. A case of primary non-Hodgkin's lymphoma of the myometrium with involvement of bilateral ovaries. Basic Appl Pathol. 2009;2:40-3.

Frey NV, Svoboda J, Andreadis C, Tsai DE, Schuster SJ, Elstrom R, et al. Primary lymphomas of the cervix and uterus: The University of Pennsylvanias experience and a review of the literature. Leuk Lymphoma. 2006;47(9):1894-901.

Bode MK, Tikkakoski T, Johansson J, Johansson K, Kariniemi J, Apaja-Sarkkinen M, et al. Lymphoma of the cervix. Imaging and transcatheter arterial embolization. Acta Radiol. 2002;43(4):431-2.

Signorelli M, Maneo A, Cammarota S, Isimbaldi G, Garcia PR, Perego P, et al. Conservative management in primary genital lymphomas: the role of chemotherapy. Gynecol Oncol. 2007;104(2):416-21.

Feugier P, Van Hoof A, Sebban C. Long-term results of the R-CHOP study in the treatment of elderly patients with diffuse large B-cell lymphoma: a study by the Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol. 2005;23:4117-26.

Niitsu N. Current treatment strategy of diffuse large B-cell lymphomas. Int J Hematol. 2010;92:231-37.

Yun J, Kim SJ, Kim JA, Kong JH, Lee SH, Kim K, et al. Clinical features and treatment outcomes of non-Hodgkins lymphomas involving rare extranodal sites: a single-center experience. Acta Haematol 2010;123(1):48-54.

Su CF, Tsai HJ, Kuo C, Chen GD, Lin LY, Huang CC, et al. Primary nonHodgkins lymphoma of the uterus, cervix and parametrium treated by combined immunochemotherapy. J Obstet Gynecol Res. 2008; 34(4.2):749-53.

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Published

2017-08-28

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Section

Case Reports