Primary cervical lymphoma: Report of two cases and review of the literature

doi:10.1016/j.ygyno.2005.04.040

Gynecologic Oncology

Volume 98, Issue 3, September 2005, Pages 484-489

https://doi.org/10.1016/j.ygyno.2005.04.040 Get rights and content

Abstract

Background.

Primary lymphoma arising from the female genital tract has been rarely encountered. Primary cervical lymphoma is even rarer in gynecologic oncology practice and accounts for approximately only 1% of extranodal lymphomas. In this article, two cases of cervical lymphoma are presented with a review of the available literature.

Case histories.

A 51-year-old woman presented with abnormal vaginal discharge. On pelvic examination, cervix was apparently normal; however, a solid and mobile pelvic mass was palpated. Pap smear was reported as HSIL at another institution. Radiological evaluation revealed a cervical mass with a 3 cm diameter. Histopathological evaluation of LEEP material was reported as diffuse large B cell lymphoma. We performed abdominal hysterectomy plus bilateral salphingo-oopherectomy and the patient was treated with adjuvant 6 cycles of CHOP chemotherapy. A second case was a 49-year-old postmenopausal woman who had undergone a routine gynecologic follow-up examination without any complaint at another institution. Routine cytological smear revealed HSIL. Punch biopsy under colposcopic examination presented no remarkable pathology except for a benign inflammation. Due to discordance between cytology and histology, LEEP was performed under colposcopic examination, which revealed follicular lymphoma grade III. This patient was treated with 6 cycles CHOP chemotherapy without any surgery.

Conclusion.

Primary cervical lymphoma is a rare disorder. Although most reported cases in the literature have a normal Pap smear, some may represent with co-existent cytological abnormalities. Therefore, cervical lymphomas should be kept in mind in patients with cytological abnormalities.

Introduction

Lymphomas account for 3.5% of all malignant neoplasms in the females. Approximately, 25% of all lymphomas arise from extranodal tissues, most frequently from gastrointestinal tract and skin [1], [2], [4]. Despite the increasing incidence of extranodal lymphomas during the last few decades, only 1 to 1.5% arises from female genital organs [4], [5], [6], [7]. Primary cervical lymphoma is an even more rare condition despite a huge number of invasive and preinvasive cervical neoplasms diagnosed worldwide per year [9]. Therefore, there is still no consensus on the management of cervical lymphomas (1–47, Table 1).

In this report, two cases of primary cervical lymphoma diagnosed by LEEP are reported and associated literature is discussed.

Section snippets

Patient 1

Fifty-one-year-old parous women presented with abnormal vaginal discharge for 2 years. She had been treated with different combined antifungal and antibiotic regimens but her complaints did not respond to these therapies. Her initial Pap smear was reported as inflammation and smear 1 year later was reported as HSIL after which she was admitted to our clinic. On gynecologic examination, the uterus was slightly larger than normal size. Also a solid, mobile pelvic mass was palpated. Cervix was

Discussion

Although secondary involvement of the female genital organs might be seen in up to 40% of disseminated lymphomas, primary genital lymphomas are rarely encountered. They are most commonly localized in the ovaries (49%), uterus (29%) and fallopian tubes (11%) [1], [11], [13], [14]. Primary cervical lymphomas are defined as the lymphomas, which originate and localize from the uterine cervix without any myometrial involvement and without any evidence of leukemia at the time of diagnosis [11], [12].

References (45)

M.A. Olde Scholtenhuis et al.
Non-Hodgkin lymphoma of the female genital tract. A five case series
Eur. J. Obstet. Gynecol. Reprod. Biol.
(2002 (Aug. 5))
T.R. Trenhaile et al.
Primary pelvic non-Hodgkin's lymphoma
Obstet. Gynecol.
(2001 (May))
T. Perren et al.
Lymphomas of the cervix and upper vagina: a report of five cases and a review of the literature
Gynecol. Oncol.
(1992 (Jan.))
H.C. Kuo et al.
Primary malignant lymphoma of the uterine cervix shows favorable response to neoadjuvant chemotherapy
Gynecol. Oncol.
(1994 (Mar.))
P.D. Gutman et al.
T-cell-rich B-cell lymphoma and Epstein–Barr virus infection of the uterus in a postmenopausal patient with an intrauterine contraceptive device in place for over 20 years
Gynecol. Oncol.
(1998 (Mar))
D.C. Pham et al.
HIV-associated primary cervical non-Hodgkin's lymphoma and two other cases of primary pelvic non-Hodgkin's lymphoma
Gynecol. Oncol.
(2003 (Jul.))
B. Piura et al.
Lymphoma-like lesion of the uterine cervix
Eur. J. Obstet. Gynecol. Reprod. Biol.
(2001 (Aug.))
A. Szantho et al.
Primary non-Hodgkin's lymphoma of the uterine cervix successfully treated by neoadjuvant chemotherapy: case report
Gynecol. Oncol.
(2003 (Apr.))
R. Mann et al.
Primary lymphoma of the uterine cervix
Gynecol. Oncol.
(1987 (Jan.))
P. Strang et al.
Primary aneuploid lymphoma of the uterine cervix: a case report
Gynecol. Oncol.
(1988 (Jun.))

R. Sandvei et al.

Successful pregnancy following treatment of primary malignant lymphoma of the uterine cervix

Gynecol. Oncol.

(1990 (Jul.))

J.T. Awwad et al.

Primary malignant lymphoma of the uterine cervix: is radiotherapy the best therapeutic choice for stage IE?

Gynecol. Oncol.

(1994 (Jan.))

R. Makarewicz et al.

Non-Hodgkin's lymphoma of the uterine cervix: a report of three patients

Clin. Oncol. (R. Coll. Radiol.)

(1995)

N.P. Baxter et al.

Primary malignant follicular lymphoma of the cervix: a rare cause of postmenopausal bleeding

BJOG

(2003 (Mar.))

O. Visser et al.

Incidence of cancer in the Netherlands, 1997

R. Komaki et al.

Malignant lymphoma of the uterine cervix

Cancer

(1984 (Oct 15))

C. Freeman et al.

Occurrence and prognosis of extranodal lymphomas

Cancer

(1972 (Jan.))

F.J. Taussig

Sarcoma of the vulva

Am. J. Obstet. Gynecol.

(1937)

A.G. Glass et al.

The national cancer database report on non-Hodkin's Lymphoma

Cancer

(1997)

R.A. Smith et al.

American Cancer Society guidelines for the early detection of cancer, 2004

CA Cancer J. Clin.

(2004 (Jan.–Feb.))

P.H. Wang et al.

Primary malignant lymphoma of the cervix in pregnancy. A case report

J. Reprod. Med.

(1999 (Jul.))

H. Fox et al.

Primary malignant lymphoma of the uterus

J. Clin. Pathol.

(1965 (Nov.))

Cited by (62)

Derepressing of STAT3 and USP7 contributes to resistance of DLBCL to EZH2 inhibition
2023, Heliyon
Diffuse large B-cell lymphoma is the most common subtype of lymphoma, representing ∼25 % of non-Hodgkin lymphoid malignancies. EZH2 is highly expressed in Diffuse large B-cell lymphoma and ∼22 % of patients contain EZH2 mutations. EZH2 have been studied as a potential therapeutic target for a decade, but efficient inhibition of EZH2 did not robustly kill lymphoma cells. Here, we found that EZH2 mediates repression of oncogenic genes STAT3 and USP7 in Diffuse large B-cell lymphoma cells. Inhibition of EZH2 leads to upregulation of STAT3 and USP7 at both RNA and protein levels. Along with USP7 upregulation, MDM2 is upregulated and its ubiquitylation substrate, Tumor suppressor P53, is downregulated. Upregulation of STAT3 and downregulation of p53 can strength cell proliferation and prevent cells from apoptosis, which suggests resistance mechanisms by which cells survive EZH2 inhibition-induced cell death. Short-course co-inhibition of USP7 and EZH2 showed increased apoptosis and cell proliferation prevention with the concentration as low as 0.08 μM. In STAT3 and USP7 depleted cells, EZH2 inhibition shows superior efficacy of apoptosis, and in EZH2 depleted cells, USP7 inhibition also shows superior efficacy of apoptosis. Thus, our findings suggest a new precision therapy by combinational inhibition of EZH2 with STAT3 or USP7 for Diffuse large B-cell lymphoma.
Invasive cervical cancer
2023, DiSaia and Creasman Clinical Gynecologic Oncology
Diagnosis of uterine lymphoma on cervical pap smear: Case report and review of literature
2021, Human Pathology: Case Reports
Hematolymphoid neoplasms rarely involve the cervix, with an overall incidence of less than 1% among all cervical malignancies. Clinical presentations include abnormal uterine bleeding, pelvic discomfort, dyspareunia, back pain and vaginal discharge. Cervical Papanicolaou Smear is an important screening tool for early detection of cervical epithelial lesions; however, a high index of suspicion is needed to recognize non-epithelial malignancies like lymphoma. We report the case of a 48-year-old woman who presented with abnormal vaginal bleeding. Pap smear showed large atypical discohesive cells with vesicular chromatin and prominent nucleoli. A cell block preparation with immunohistochemistry confirmed large B-cell lymphoma. This diagnosis is important due to management strategy differences of chemoradiation over surgery in hematologic malignancies. A review of literature of hematologic malignancies diagnosed on Pap smear is also reported.
Blastic variant of plasma cell myeloma mimicking squamous cell carcinoma of the uterine cervix in a super-morbidly obese female
2019, Gynecologic Oncology Reports
Citation Excerpt :
Female genital tract involvement by non-Hodgkin's lymphoma is a rare clinical phenomenon. The disease can arise from lymph nodes and secondarily involve the female genital organs in up to 40% of disseminated lymphomas (Dursun et al., 2005). Primary lymphoma of the female genital tract is extremely rare, with diffuse large B-cell lymphoma (DLBCL) being the most common histologic subtype (Nasioudis et al., 2017).
A case of primary cervical lymphoma in a patient with abnormal uterine bleeding
2018, Gynecologic Oncology Reports
Citation Excerpt :
Due to its infrequent presentation, its exact incidence is unknown (Stroh et al., 1995). The median age of presentation is in the fourth decade although documented cases range from age 20 to 80 (Dursun et al., 2005; Cheong et al., 2000). Initial presenting complaints are typically non-specific and include irregular bleeding, vaginal discharge, or a symptomatic pelvic mass (Korivi et al., 2014).
Primary lymphoma of the uterine cervix is a rare site of extranodal lymphoma. Many gynecologic oncologists may go their entire career without encountering one. Patients may present with symptoms of abnormal or postmenopausal bleeding, and diagnosis may be challenging as typical office tests such as the pap smear may not detect the abnormal cells. Once a diagnosis is made, management may be debated due to the rarity of the condition and lack of accepted standard treatment. However, most patients respond well to some version of chemotherapy and radiation typically used for standard lymphomas. Prognosis is favorable if the patient is diagnosed early in the disease process.
Invasive cervical cancer
2018, Clinical Gynecologic Oncology

View all citing articles on Scopus

View full text

ReviewPrimary cervical lymphoma: Report of two cases and review of the literature

Abstract

Background.

Case histories.

Conclusion.

Introduction

Section snippets

Patient 1

Discussion

Eur. J. Obstet. Gynecol. Reprod. Biol.

Obstet. Gynecol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Eur. J. Obstet. Gynecol. Reprod. Biol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Gynecol. Oncol.

Clin. Oncol. (R. Coll. Radiol.)

BJOG

Incidence of cancer in the Netherlands, 1997

Malignant lymphoma of the uterine cervix

Cancer

Occurrence and prognosis of extranodal lymphomas

Cancer

Sarcoma of the vulva

Am. J. Obstet. Gynecol.

The national cancer database report on non-Hodkin's Lymphoma

Cancer

American Cancer Society guidelines for the early detection of cancer, 2004

CA Cancer J. Clin.

Primary malignant lymphoma of the cervix in pregnancy. A case report

J. Reprod. Med.

Primary malignant lymphoma of the uterus

J. Clin. Pathol.

Review
Primary cervical lymphoma: Report of two cases and review of the literature