Primary uterine non-Hodgkin's lymphoma:a rare case report and review of the literature

Abstract

Primary uterine non-Hodgkin lymphoma (NHL) is rarely reported, as its incidence is extremely low. We describe a 72 year old patient with primary uterine non-Hodgkin's lymphoma stage IV, diffuse B-cell large cells, who responded well to cytotoxic chemotherapy (R-CHOP). Radiological investigations exhibited certain characteristics, including magnetic resonance T2 weighted imaging, enhanced scanning, diffusion weighted imaging and apparent diffusion coefficient values. The lesion in the anterior wall of the uterine body was relatively large, with a size of about 34mm×47mm×43mm. The gold standard for diagnosis is still the pathological examination of a biopsy specimen, which revealed diffuse large cell of B lineage. This article reviews data collected from 141 patients in the literature.

Keywords: diffuse large b-cell lymphoma (DLBCL); diffusion weighted imaging; magnetic resonance (MR) imaging; non Hodgkin lymphoma (NHL); primary uterine non-Hodgkin lymphoma (NHL).

Figure 1

Magnetic resonance imaging scans of an 72-year-old female patient with a pelvic mass showed the following: (A, B, D, E) an enlarged uterus; (F) the arterial phase enhancement of the lesion was significantly uneven, the degree of venous phase enhancement was lower than that of the normal uterine myometrium. (C) The apparent diffusion coefficient (ADC) value of uterine mass was 0.751×10^-3 mm²/s.

Figure 2

Computed tomography (CT) imaging scans of an 72-year-old female patient with a pelvic mass for more than 1 month: (A) plain CT imaging showed an enlarged uterine volume, soft tissue density shadow in the anterior wall of the uterus, with unclear boundary; (B–D) enhanced CT imaging(arterial phase[b]; venous phase[c]; delay phase[d]) showed that the lesion were slightly enhanced, the boundary was clear; (E–H) after treatment, enhanced CT imaging(arterial phase[f]; venous phase[g]; delay phase[h]) showed that the volume of the uterus had significantly reduced(plain CT imaging[e]).

Figure 3

HE staining of the specimen (×40) (A), (×200) (B), and immunohistochemical examination revealed CD10 (+) (C), CD20 (+) (D), Bcl-6 (+) (E), CD3(+) (F), C-myc(+) (G), Ki-67(+) (H), LCA(+) (I), MUM1(+) (J), P53(+) (K), Pax-5(+) (L), Vimentin(+) (M) and suggested a diffuse large B-cell lymphoma. HE, hematoxylin.