Lymphoma is a malignancy that originates from lymph nodes, extranodal lymphoid tissue, or lymphocytes. According to the location of lymphoma, it is divided into lymphadenopathy and extranodal lymphoma, of which the incidence of extranodal lymphoma accounts for 25%-50%, but because of its extensive primary site, the corresponding complex and diverse clinical manifestations, and lack of clinical specificity, it is easy to cause missed diagnosis or misdiagnosis, thereby missing the best treatment time and greatly reducing its cure rate.
Recently, the Gynecology Department of Hunan Provincial Second Personnel Hospital (Hunan Provincial Brain Hospital) successfully carried out a case of extrauterine lymphoma resection. Hunan 55-year-old Ms. Liao, a patient with diffuse large B-cell lymphoma after radiotherapy, gradually bulged after menopause for half a year, thinking that it was fat and not paying attention to it; in the past 2 days, there was no obvious cause of irregular vaginal bleeding, Ms. Liao thought that she had menstruation again, and went to The Hunan Provincial Maternal and Child Health Hospital for examination, the color ultrasound showed that there was a huge lump in the pelvic abdominal cavity, and the diagnosis considered uterine cancer or sarcoma.
Ms. Liao then came to the Gynecology Department of the Second People's Hospital of Hunan Province to seek surgical treatment. Pelvic enhancement CT after admission shows a large mass in the uterine body, which is more likely to be considered malignant. Surgery is usually required, but because the patient has diffuse large B-cell lymphoma, the bone marrow suppression state after radiotherapy and chemotherapy is serious, and the surgical risk is extremely high and the difficulty is high.
After multidisciplinary consultation and discussion, Professor Wang Guohua of cardiology believes that after the previous targeted treatment, the patient's condition is currently stable, and there are no swollen lymph nodes and lumps in other parts, and at the same time, considering that the patient's current heart condition is still tolerable and has the opportunity for surgery.
After sufficient preoperative preparation and multi-faceted communication with the family, after 1 week of hospitalization, under the coordination of the departments of anesthesiology, urology and cardiology, the transabdominal uterus plus bilateral adnexal resection was performed under the general anesthesia intubation, and the internal uterine mass of about 19×12×11cm was successfully removed, weighing 2.8 kg.
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Postoperative pathological biopsy morphology combined with immunohistochemical examination, the tumor is non-Hodgkin B-cell lymphoma, highly invasive, tending to diffuse large B-cell lymphoma (non-germination center cytogenesis). After the treatment of nursing support, anti-infection, chemotherapy, maintenance of electrolyte balance, stomach protection, etc., the patient's condition improved and he was discharged from the hospital, and the recent prognosis was good.
Primary intrauterine (cervical/uterine) lymphoma is very rare, and there are few reports of clinical and pathological discussions and imaging features. Primary uterine lymphomas are overwhelmingly non-Hodgkin lymphomas, most commonly diffuse large B-cell lymphomas. The specific reasons are not clear, but may be related to human immunity to viruses.
The disease is more common in middle-aged and elderly people, the patients are mostly 36-60 years old, the most common clinical manifestations are abnormal vaginal bleeding, and when the mass is larger, there is abdominal and pelvic discomfort, pelvic mass, low back pain, etc. Because the disease is very rare, it is easily misdiagnosed as cervical cancer or uterine fibroids with necrosis.
According to Ann Arbor staging, the 5-year survival rate in patients with stage III-IV female reproductive malignant lymphoma is only 31%. The clinical stage, pathological type, serum LDH level, regional lymph node tumors, group B symptoms, and treatment regimens of the disease all affect the prognosis of patients. Therefore, for intrauterine malignant lymphoma, a clear diagnosis and a reasonable choice of treatment are key.
Contributed by: Xu Qin, Second People's Hospital of Hunan Province (Hunan Brain Hospital).
Editor: Liu Yuchen
Image: Gynecology