Synchronous multiple primary cancers involving cervical cancer and follicular lymphoma: A case report

Abstract

Multiple primary cancers refers to the occurrence of two or more histologically distinct tumor types, either simultaneously or sequentially. The present report describes a rare case of a 46-year-old female patient simultaneously diagnosed with cervical cancer and low-grade follicular lymphoma (FL). The patient presented with vaginal bleeding and a subsequent cervical biopsy confirmed cervical squamous cell carcinoma. Imaging examinations indicated suspicious para-aortic lymph node metastasis, leading to a laparoscopic radical hysterectomy with lymph node dissection. Postoperative histopathological examination revealed cervical squamous cell carcinoma. However, para-aortic lymph node metastasis was not observed and instead, primary FL was detected. The current case underscores the importance of surgical intervention in cases where cervical cancer presents with isolated para-aortic lymph node enlargement, as it is essential for distinguishing between lymph node metastasis and the presence of a second primary tumor.

Keywords: FL; MPC; cervical cancer; isolated para-aortic lymph node enlargement.

Figure 1.

Radiological examination findings. Magnetic resonance imaging findings of the cervical mass: (A) Coronal view and (B) sagittal view. Positron emission tomography-computed tomography revealed abnormal metabolic activity in the (C) cervix and (D) para-aortic lymph nodes. Images illustrating (E) the range of the radiation therapy target area for the retroperitoneal lymph node drainage area and (F) the planning target volume for the residual vaginal stump and lymph node drainage area. Please note the following clarification: In panels A, B and C, the arrows indicate the location of the cervical mass, while in panel D, the arrows point to the para-aortic lymph nodes.

Figure 2.

Histopathological findings of the cervical mass. (A) H&E staining revealed squamous cell carcinoma in the cervix. Immunohistochemical examination indicated malignant cells immunoreactive for (B) CK5/6, (C) P40 and (D) P16 (scale bar, 100 µm). CK5/6, cytokeratin 5/6 antibodies; P40, subunit β of interleukin 12; P16, cyclin-dependent kinase inhibitor 2A.

Figure 3.

Pathological features of Hodgkin lymphoma components. (A) H&E staining revealed the presence of heterogeneous follicles within the lymph node, accompanied by a prominent perifollicular zone rich in lymphocytes, forming well-defined germinal centers. Tumor cells exhibited positive immunohistochemistry staining for (B) CD20, (C) CD10, (D) Bcl-6, (E) PAX-5 and (F) Bcl-2 (scale bar, 100 µm). PAX-5, paired box 5.

Figure 4.

Flowchart for the diagnosis and management of cervical cancer with suspected lymph node metastasis. EBRT, external beam radiation therapy.