Primary extranodal marginal zone B-cell lymphoma of the fallopian tube

An Unusual Case of Extranodal Marginal Zone Lymphoma Mimicking Abdominal Cocoon Syndrome in an Adolescent Patient

Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is an indolent non-Hodgkin lymphoma rarely seen in pediatric patients. MALT lymphoma most commonly involves the gastrointestinal tract or peri-orbital tissues, potentially as sequela of chronic antigenic stimulation or immune dysregulation. Rare cases of MALT lymphoma arising from the gynecologic tract have been reported in older adult patients. We present the unique case of a 16-year-old postpubescent female with MALT lymphoma localized to the gynecologic tract, who initially presented with abdominal fullness, abnormal uterine bleeding, and obstructive acute kidney injury secondary to urinary outflow obstruction. Intraoperatively, dense fibrosis of the uterus and left fallopian tube was noted which mimicked abdominal cocoon syndrome. She was treated with 6 cycles of bendamustine and rituximab with complete anatomic and metabolic remission. In this report we highlight a very unusual presentation of a rare malignancy in the pediatric population as well as unique treatment considerations given this patient's young age and tumor location.

Primary mucosa-associated lymphoid tissue lymphoma in fallopian tubes: A case report and literature review

RATIONALE

Mucosa-associated lymphoid tissue (MALT) lymphoma accounts for 7%-8% of newly diagnosed lymphomas. The stomach is the most common organ of origin (nearly 50% of MALT lymphomas). Only 2% of MALT lymphomas arise from the female genital tract, and most originated from uterus. We described a rare case of MALT lymphoma primarily arising from the fallopian tube.

PATIENT CONCERNS

A 26-year-old woman was brought into our gynecological clinic because of a history of irregular menstruation. The transvaginal ultrasonography revealed cystic masses in bilateral adnexa and both of them showed rich vasculature. Laboratory tests showed a high level (455.3 U/mL) of cancer antigen-125 (CA-125).

INTERVENTIONS

A laparoscopy was performed.

OUTCOMES

Frozen section of the removed specimen revealed acute and chronic inflammation with abundant inflammatory cells infiltrating the mesenchyme. The right fallopian tube was removed. However, the final histological results showed inflammation accompanied by hyperplasia of lymphoid tissue. Immunohistochemistry staining were consistent with MALT lymphoma. The patient received the second surgery to remove the left fallopian tube and also confirmed the same pathology.

LESSONS

Gynecologists should be aware of cystic masses which showed rich vasculature and high level of CA-125.

Successful pregnancy via in vitro fertilization in a primary infertile woman with primary lymphoma of the fallopian tube after surgery: A case report and literature review

RATIONALE

Primary extranodal marginal zone B-cell lymphomas of the fallopian tube is extremely rare. It is a great challenge for fertility and gynecology doctors to manage such cases and also fulfil the reproductive demands of these young women.

PATIENT CONCERNS

A 30-year-old woman consulted for a 5-year primary infertility.

DIAGNOSIS

According to the Ann Arbor staging system, a stage IE extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue lymphoma was diagnosed for this patient based on tumor pathology, bone marrow biopsy, hysteroscopy and whole-body positron emission tomography imaging. She also had endometriosis based on laparoscopy.

INTERVENTIONS

The patient underwent a laparoscopic bilateral salpingostomy without additional surgery or radiotherapy and chemotherapy for fertility preservation, and received 5 months of long-acting gonadotropin releasing hormone agonist treatment for endometriosis.

OUTCOMES

Two years after the surgery, the patient delivered a healthy neonate through in vitro fertilization-embryo transfer procedures. The patient is now 3 years post-op and 1 year post-delivery, long-term follow-up suggested that the patient remained cancer-free up till now.

LESSONS

More care should be taken when the newly diagnosed mass is combined with a rather high serum CA-125 level. Although endometriosis and ovarian cancer are more common, lymphoma cannot be ruled out.

Primary diffuse large B-cell lymphoma of the fallopian tube treated with a combination of surgery and chemotherapy: Case report

RATIONALE

Primary female genital tract lymphomas are sporadic neoplasms, accounting for 0.2% to 1.1% of all cases of extranodal lymphoma. The most common genital localizations are the cervix, the uterine corpus and the ovary, while primary lymphomas of the fallopian tube are quite unusual. According to literature searching in PubMed, this is the first reported case of primary diffuse large B-cell lymphoma of the fallopian tube.

PATIENT CONCERNS

A 52-year-old woman presented with a more than 2 months history of intermittent lower abdominal pain. The gynecological examination showed that the uterus, as big as 3 months of pregnancy, had weak activity and no tenderness. The uterine rectum lacuna was like a hard nodule of about 3 × 2 cm, and an irregular solid mass was fixed and inactive in the right adnexa.

DIAGNOSES

In accordance with Ann Arbor staging system, a stage IE primary diffuse large B-cell lymphoma of fallopian tube was diagnosed for this patient, based on the tumor pathology, the results of bone marrow biopsy and computed tomography (CT) scan.

INTERVENTIONS

After gynecological/urinary ultrasound, blood test, pelvic contrast enhanced CT scan and CT angiography of iliac artery, exploratory laparoscopy and following hysterectomy with bilateral salpingo-oophorectomy were performed. After the surgery, the patient was treated with combined Rituximab and chemotherapy and got complete response (CR).

OUTCOMES

After the operation and R-CHPOP, following up for more than 1 year so far, the patient has no tumor recurrence and is still in good condition.

LESSONS

It is very difficult to diagnose the primary diffuse large B-cell lymphoma of fallopian tube, not only because of its rarity, but also because of its non-specific clinical manifestations. It easily be treated as late ovarian cancer by gynecologist. So the pathology diagnosis and surgeons' decision is very important. Because lymphoma is pretty sensitive to chemotherapy and easy to get complete response, so we no need to do an operation like ovarian cancer and should put chemotherapy as a primary method for lymphomas of the female genital tract.

Primary lymphoma of the uterine horn in a Lhasa Apso dog

Primary lymphomas of the canine female genital tract are uncommon tumours. A 9-year-old intact female Lhasa Apso dog presenting with a closed pyometra underwent an ovariohysterectomy (OHE), and the hyperplastic uterine horn along with multiple follicular cysts on the right ovary was examined by histological analysis. Severe infiltration of medium-sized lymphocytes with strong positive immunoreactivity for CD79a and numerous anaplastic features was detected in the unilateral uterine horn, and the dog was diagnosed as having extranodal marginal zone B-cell lymphoma (MZBCL). The present case reports an extremely rare occurrence of primary lymphoma involving the uterine horn in a dog and describes histological characteristics of the tumour for definite diagnosis.

A rare case of primary extranodal marginal zone B-cell lymphoma of the ovary, fallopian tube, and appendix in the setting of endometriosis

Extranodal marginal zone B-cell lymphomas are uncommon. Most occur in the gastrointestinal tract. Marginal zone B-cell lymphomas of the female genital tract are rare, and few cases exist of marginal zone B-cell lymphomas of the uterus, cervix, and fallopian tubes. We report the first marginal zone B-cell lymphoma of the ovary, fallopian tube, and appendix arising in endometriosis.

Primary extranodal marginal zone B-cell lymphoma of MALT-type involving the fallopian tube

► We experience one case of MZBL of MALT type in the fallopian tube. ► There was no remarkable inflammatory or infection sign. ► We report this case with a review of related literature.

Primary follicular lymphoma of the fallopian tube found incidentally in a patient treated for endometrial carcinoma: a case report

We report a rare case of primary lymphoma of fallopian tube in a 68-year-old woman who underwent total hysterectomy and bilateral salpingo-oophorectomy for endometrial carcinoma. The specimen showed a well-differentiated endometrioid adenocarcinoma with superficial myometrial invasion. The left fallopian tube revealed a 1 cm nodule that histologically showed diffuse lymphoid follicles consisting of small cleaved lymphocytes and occasional larger cells. The cells were immunopositive for CD20, BCL-2, and BCL-6 but negative for CD3 and CD43. Polymerase chain reaction confirmed a monoclonal B-cell population. Fluorescence in-situ hybridization revealed at (14, 18) translocation. The patient had absent lymphadenopathy and negative CT scan of chest, abdomen, and pelvis. The findings were consistent with a primary low grade follicular lymphoma of fallopian tube. She did not receive chemotherapy and remained disease free for 13 months after surgery. Our case suggests that primary lymphoma of fallopian tube may be associated with a favorable prognosis.

Lymphoma of the female genital tract: current status

SUMMARY

: Primary lymphomas affecting the female reproductive system are uncommon but often pose a diagnostic challenge if their existence is not suspected. This article reviews the pathological and clinical features of lymphomas occurring in various sites in the female genital tract including the vulva, vagina, cervix, endometrium, fallopian tubes, and ovaries. Using the recent World Health Organization classification, the various types of lymphomas are identified as separate diseases and not as morphological variations of the same disease. The immunophenotypic and cytogenetics features of the major lymphomas are summarized. The incidence, presenting symptoms, gross and microscopic features, major differential diagnostic considerations, response to therapy, and expected outcome are discussed. Using published data on patient outcome, the International Federation of Obstetricians and Gynecologists and Ann Arbor staging systems are compared for their predictive value, and the difficulty in assigning primary and secondary status in extranodal lymphomas is emphasized. The observed differences in the behavior of some lymphomas in gynecological sites compared with their usual nodal location are presented. Finally, the possible etiology of these conditions is discussed in light of the emerging paradigm of mucosa-associated lymphoid tissue lymphomas.

Bilateral peripheral T-cell lymphoma of the fallopian tubes

BACKGROUND

Lymphoma of the female genital tract is rare, and usually involves the ovaries or the uterus. Most cases of fallopian tube lymphoma reflect disease arising in the ovaries. All previously reported cases of primary lymphoma of the fallopian tube were of B cell lineage.

CASE

A 51-year-old woman presented with systemic upset and a pelvic mass. At laparotomy, both fallopian tubes were inflamed and histological examination revealed peripheral T-cell lymphoma. At staging, she had IIB(E) disease, and she was treated with six cycles of CHOP-M chemotherapy.

CONCLUSION

Our case is unusual in that this is the first described case of peripheral T-cell lymphoma arising in the fallopian tubes and is moreover unusual because of the involvement of both fallopian tubes without involvement of other gynaecological organs. The clinical course was favourable with complete remission maintained for more than 5 years.

Primary extranodal marginal zone B-cell lymphoma of MALT type of the endometrium

BACKGROUND

Only one case of primary extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) of the endometrium has been previously reported.

CASE

A 65-year old patient presented with postmenopausal bleeding. She was found to have endometrial polyps. The endometrial curettings showed a dense lymphoid infiltrate that was suggestive of a lymphoproliferative disorder. Histological examination of the total abdominal hysterectomy revealed primary extranodal marginal zone B-cell lymphoma (MALT-type lymphoma) of the endometrium. The diagnosis was supported by morphology, immunohistochemistry, and molecular analysis.

CONCLUSIONS

Extranodal MALT lymphoma of the endometrium is exceptionally rare although the female genital tract is rich in mucosa and the presence of MALT tissue has been previously described. The diagnosis of lymphoproliferative disorder in this case was initially made on endometrial curettings. Although most lymphoid aggregates within endometrial curettings are due to reactive conditions such as endometritis, the possibility of lymphoma must be kept in mind when dense lymphoid aggregates or atypical lymphoid cells are present in the curettings.