Diffuse Large B-cell Lymphoma: An Uncommon Dweller in the Uterus
Introduction
Lymphomas are immune system neoplasms and based on location they can be divided into nodal lymphomas- arising in lymph nodes, or extra nodal lymphoma. Extra nodal lymphomas are further classified as primary or secondary. The most frequent sites for the extra nodal types are gastrointestinal tract and the skin, up to 25% of all cases of lymphomas. [1] Primary female genital system lymphoma (PFGSL) of the reproductive system is a rare disease, accounting for only 0.21-1.1% of extra nodal lymphoma. [2, 3]
Rarity and non specific presentation of primary malignant lymphomas in the female genital tract leads to diagnostic challenge and delay of treatment.
Case: Here, we presented a case of 57 year female with complaint of post menopausal bleeding. On clinical evaluation an enlarged uterus with mass in uterine cavity on ultrasonography found, for which endometrial biopsy was taken that showed a poorly differentiated malignant neoplasm and misdiagnosed on MRI imaging as Leiomyomasarcoma. So after total abdominal hysterectomy with bilateral salpino- oophorectomy a definitive diagnosis of primary diffuse large B cell lymphoma (DLBCL) of the uterus was made on histopathology and immunohistochemistry study. [Figure 1 & 2]
So present case also highlights the role of pathology in prompt diagnosis and treatment of this rare tumour. The treatment of patients should be individualized with the following options: surgery, radiotherapy and/or chemotherapy.
Keywords: Diffuse large B cell lymphoma, female genital tract, uterus
Figure 1: (a) Uterus cervix with large polypoidal mass in uterine cavity. (b, c, d) Diffuse sheets of tumour cells with benign glands in between (H & E, X40 & X100)
Figure 2: (a, b, c, d) Diffuse strong immunoreactivity for LCA, CD 20, PAX 5 & Ki 67 respectively ( X100)