engleski

Primary asymptomatic malignant lymphoma of the uterus: a case report

The female genital tract is rarely the initial manifestation site of malignant lymphomas (MLs). Its frequency in Western countries was reported to be 0.008% among primary genital tumors and 2% among extranodal lymphomas in women. The most common diagnosis is diffuse large B cell lymphoma. MLs usually arise in the vagina or cervix. Infrequently, ML may involve the uterus. Non-Hodgkin's lymphomas involving the uterus may be either low-stage neoplasms that probably arise in the uterus (primary) or systemic neoplasms with secondary involvement. We present a 77-year old woman with a primary ML of the corpus uteri. Her menopause had occurred in 1987. She had no symptoms. During the control check up, she underwent pelvic ultrasound that revealed a 3.2x3.4 cm inhomogeneous lesion located within the uterine cavity (RI 0.38). Non-Hodgkin diffuse large B cell lymphoma was diagnosed in a curettage specimen. PET CT findings showed a lesion confined to the uterus without evidence of disease in the head, neck, chest or abdomen. There were no enlarged lymph nodes. The patient was treated by chemotherapy. Treatment was started with series of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy under supervision of the hematology department. After 8 courses of chemotherapy a control CT was performed, which showed complete remission. Our patient had relapse and multiple recurrences of lymphoma with progression and death 3 year after the initial diagnosis. Lymphomas presenting with initial manifestations of female genital tract disease are extremely uncommon. Patients usually present with vaginal bleeding and abdominal or pelvic discomfort, but very infrequently the tumors are discovered as a result of a routine examination, as presented in our case. Due to low incidence of primary uterine lymphoma, large patient series describing the optimal treatment method are not available ; therefore, the treatment of patients with a primary uterine lymphoma needs to be individualized. This case draws our attention to the importance of considering MLs in the differential diagnosis of a intracavitary uterine abnormality.

Malignant lymphoma; Uterus; Chemotherapy

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