Lymphoma of the uterine cervix – a rare clinical presentation

Dušica Petrović Rodić; Tatjana Kastratović; Danijela  Jovanović; Vladan Marković; Jasmina Stojanović; Dalibor Jovanović

doi:10.2298/VSP210707080P

Dušica Petrović Rodić University of Kragujevac, Faculty of Medical Sciences, Department of Pathology, Kragujevac, Serbia
Tatjana Kastratović University Medical Center Kragujevac, Department of Gynecology and Obstetrics, Kragujevac, Serbia
Danijela Jovanović University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Kragujevac, Serbia
Vladan Marković University of Kragujevac, Faculty of Medical Sciences, Department of Radiology, Kragujevac, Serbia
Jasmina Stojanović University of Kragujevac, Faculty of Medical Sciences, Department of Otorhinolaryngology, Kragujevac, Serbia
Dalibor Jovanović University of Kragujevac, Faculty of Medical Sciences, Department of Pathology, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP210707080P

Keywords: biopsy, lymphoma, non-hodgkin, papillomaviridae, serotyping, uterine cervical dysplasia

Abstract

Introduction. Lymphomas are malignant diseases of the lymphocyte lineage. There are two basic types of lymphoma: Hodgkin's lymphoma (HL), whose main characteristic is the presence of Reed-Sternberg cells, and non-Hodgkin's lymphoma (NHL), which presents a heterogeneous group of diseases, and depending on the growth rate and the course of the disease, they can be indolent (slow-growing) and aggressive (fast-growing). Follicular lymphoma (FL) is the most common indolent form of NHL, while diffuse large B-cell lymphoma (DLBCL) is the most common aggressive form. Case report. The study presents a case of NHL, DLBCL, localized in the cervix, histopathologically diagnosed in a 35-year-old woman who, after a cervical biopsy, was histopathologically diagnosed with mild dysplasia (CIN1/L-SIL) of the cervical epithelium and, after that, an infection with human papillomavirus (HPV) subtypes 16 and 31 was proven. The diagnosis of DLBCL was histopathologically confirmed on a conical section of the vaginal portion of the uterus, after which the disease was treated with eight cycles of chemotherapy according to the RCHOP protocol. Conclusion. The coexistence of CIN1/L-SIL and NHL is random. However, this fact may cause the concomitant cervical lymphoma to be overlooked since the lymphoma is usually subepithelial if biopsies are not taken adequately and if HPV serotyping of the biopsy sample is not performed.

References

1. Korcum AF, Karadogan I, Aksu G, Aralasmak A, Erdogan G. Primary follicular lymphoma of the cervix uteri: a review. Ann Hematol 2007; 86(9): 623‒30.

2. Carbone PP, Kaplan HS, Musshoff K, Smithers DW, Tubiana M. Report of the Committee on Hodgkin's Disease Staging Classification. Cancer Res 1971; 31(11): 1860‒ 1.

3. Matasar MJ, Zelenetz AD. Overview of lymphoma diagnosis and management. Radiol Clin North Am 2008; 46(2): 175‒98, vii.

4. Miranda-Filho A, Piñeros M, Znaor A, Marcos-Gragera R, Steliarova-Foucher E, Bray F. Global patterns and trends in the incidence of non-Hodgkin lymphoma. Cancer Causes Control 2019; 30(5): 489‒99.

5. Del M, Angeles MA, Syrykh C, Martínez-Gómez C, Martínez A, Ferron G, et al. Primary B-Cell lymphoma of the uterine cervix presenting with right ureter hydronephrosis: A case report. Gynecol Oncol Rep 2020; 34: 100639.

6. Wang J, Zeng L, Chen S, Wu Q, Ma L, Wu S, et al. Lymphoma of the female genital tract: a clinicopathological analysis of 25 cases. Am J Transl Res 2019; 11(9): 5800‒11.

7. De Greve T, Vanwalleghem L, Van Hoof A, Coenegrachts K, Van Trappen P. An unusual cervical tumor as presentation of a non-hodgkin lymphoma. Case Rep Obstet Gynecol 2014; 2014: 549619.

8. Selvi Demirtas G, Gokcu M, Sancı M, Ekmekci S, Yıldız HI. Primary non-Hodgkin's lymphoma masquerading as cervical cancer. Ginekol Pol 2020; 91(9): 571.

9. Pratap S, Scordino TS. Molecular and cellular genetics of non-Hodgkin lymphoma: Diagnostic and prognostic implications. Exp Mol Pathol 2019; 106: 44‒51.

10. Roman E, Smith AG. Epidemiology of lymphomas. Histopathology 2011; 58(1): 4‒14.

11. Intaraphet S, Farkas DK, Johannesdottir Schmidt SA, Cronin-Fenton D, Søgaard M. Human papillomavirus infection and lymphoma incidence using cervical conization as a surrogate marker: a Danish nationwide cohort study. Hematol Oncol 2017; 35(2): 172‒6.

12. Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American Cancer Society. CA Cancer J Clin 2020; 70(5): 321‒46.