1
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Chen H, Zhuang J, Zhang W, Zhou D, Wang X, Jia C, Zhao D. Vaginal involvement as a rare extranodal manifestation in advanced-stage follicular lymphoma: a case report and literature review. Ann Hematol 2024:10.1007/s00277-024-05950-2. [PMID: 39177796 DOI: 10.1007/s00277-024-05950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 08/14/2024] [Indexed: 08/24/2024]
Abstract
Apart from bone marrow involvement, extranodal involvement of follicular lymphoma (FL) is rare. Gynecologic FL is seldom reported, among which the vagina is the rarest involved site. No vaginal involvement in advanced-staged FL was reported before. Here, we report a case of FL with systemic involvement including the vagina.
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Affiliation(s)
- Hongyun Chen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Junling Zhuang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Daobin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xiaoyu Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Congwei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Danqing Zhao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
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2
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Fan W, Sun S, Wang J, Lv Y, Chen Y. Development and validation of nomograms to predict survival of primary cervical lymphoma: A surveillance, epidemiology, and end results (SEER) database analysis. Medicine (Baltimore) 2024; 103:e38528. [PMID: 38875393 PMCID: PMC11175947 DOI: 10.1097/md.0000000000038528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
Due to the rarity of primary cervical lymphoma (PCL), the long-term survival of patients with cervical lymphoma and factors influencing survival are unknown. This study aimed to compare the survivals of patients with PCL and those with other cervical tumors and construct a clinical prediction model to assess the prognosis of patients with PCL. Patients with PCL from the Surveillance, Epidemiology, and End Results database were allocated randomly in a 7:3 ratio to the training and validation sets. Cox proportional hazard and Fine-Gray models were used to verify independent factors influencing overall survival (OS) and disease-specific survival (DSS), and nomograms were constructed. Receiver operating characteristic curve analysis and decision curve analysis (DCA) were used to test the performance and clinical utility of the models, respectively. We included 206 patients with PCL. The areas under the curves (AUCs) and DCA showed that all models had clinical benefits; The models constructed in this study had a predictive performance for patients with PCL. It can guide clinicians to rationalize the treatment plan for patients.
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Affiliation(s)
- Wenjuan Fan
- Department of Gynecology, Xian No. 1 Hospital, Xi'an, China
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiwei Sun
- Department of Urology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Wang
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - You Lv
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying Chen
- Department of Obstetrics and Gynecology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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3
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Magazzino F, Aristei C, Passarelli A, Pierini A, De Giorgi U, Martinello R, Domenici L, Pignata S, Mangili G, Cormio G. Lymphomas of the Vulva: A Review of the MITO Rare Cancer Group. Cancers (Basel) 2024; 16:2102. [PMID: 38893221 PMCID: PMC11171216 DOI: 10.3390/cancers16112102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/26/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Since they are very rare tumors, lymphomas of the vulva are often not properly recognized. Patients with vulvar lymphoma are generally elderly and the classical manifestation of the disease is a vulvar mass. No significant age differences have been found between primary and secondary lymphoma. To make a correct diagnosis, it is therefore necessary to use not only histological examination but also the genetic and molecular profile in order to establish optimal therapeutic management. Literature analysis confirm the good prognosis of this disease.
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Affiliation(s)
- Francescapaola Magazzino
- Complex Operating Unit Obstetrics and Gynaecology, Ospedale Civile di San Donà di Piave-Venezia, AULSS4 Veneto Orientale, 30027 San Donà di Piave, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Medicine and Surgery, Perugia General Hospital Sant’Andrea delle Fratte, University of Perugia, 06156 Perugia, Italy;
| | - Anna Passarelli
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80144 Napoli, Italy; (A.P.); (S.P.)
| | - Antonio Pierini
- Division of Hematolgy and Clinical Immunolgy, Department of Medicine and Surgery, University of Perugia, 06156 Perugia, Italy;
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy;
| | - Ruby Martinello
- Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, 44121 Ferrara, Italy;
| | - Lavinia Domenici
- 2nd Division of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria Pisana, University of Pisa, 56126 Pisa, Italy;
| | - Sandro Pignata
- Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS “Fondazione G. Pascale”, 80144 Napoli, Italy; (A.P.); (S.P.)
| | - Giorgia Mangili
- Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, 20132 Milano, Italy;
| | - Gennaro Cormio
- Gynecologic Oncoly Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, 70124 Bari, Italy;
- Department of Interdisciplinary Medicine, University of Bari, 70124 Bari, Italy
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4
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Mingola P, Alshomrani A, Greiner T. Anaplastic large cell lymphoma presenting as a mass in the uterine cervix: a case report. J Hematop 2024; 17:23-26. [PMID: 38376721 DOI: 10.1007/s12308-023-00568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024] Open
Abstract
T-cell lymphoma is an extremely rare form of malignancy in the female genital tract. Most of the reported cases of lymphoma are B-cell lymphomas. A few cases of primary T-cell lymphomas involving the vagina or the vulva have been reported. We are reporting the first case of anaplastic large cell lymphoma (ALCL) presenting as a uterine cervical mass. The patient is a 24-year-old female who presented to the emergency room with a history of menorrhagia, night sweats and 40-pound weight loss. The diagnosis of ALCL was confirmed through immunohistochemical studies with strong CD30 and ALK expression. Fluorescent hybridization showed a rearrangement of the anaplastic lymphoma kinase (ALK) gene. Since ALCL may have a variable expression of T-cell antigens, the diagnosis may easily be missed when CD45 and/or CD3 is negative, and screening epithelial stains for carcinoma (e.g., p63 and EMA) are positive. CD30 must be performed to raise the consideration of ALCL when reniform nuclei are observed.
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Affiliation(s)
- Phillip Mingola
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ahmad Alshomrani
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Timothy Greiner
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
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5
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Knox A, Meyer M, Michener JL, Major A. The Great Imitator: Aggressive Non-Hodgkin Lymphoma Presenting as a Cervical Mass. Am J Med 2024; 137:107-109. [PMID: 37757964 DOI: 10.1016/j.amjmed.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Affiliation(s)
- Adam Knox
- Internal Medicine Residency Program, University of Colorado School of Medicine, Aurora.
| | - Marita Meyer
- Internal Medicine Residency Program, University of Colorado School of Medicine, Aurora
| | - Jennifer L Michener
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Ajay Major
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, Aurora
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6
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Zhang Z, Yang Q. Primary diffuse large B-cell tumor of the uterus: a case report. Front Med (Lausanne) 2023; 10:1234861. [PMID: 37521344 PMCID: PMC10373583 DOI: 10.3389/fmed.2023.1234861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Primary diffuse large B-cell tumor of the uterus is a rare clinical condition with a similar clinical presentation to gynecologic tumors and is easily misdiagnosed. We report a case of a postmenopausal woman who presented with pelvic mass. Her ultrasound and MRI examinations suggested diffuse enlargement of the uterus, leading us to consider the diagnosis of lymphoma. The histological examination of the uterine mass confirmed the diagnosis of diffuse large B-cell lymphoma. The patient received 6 cycles of chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) and 2 cycles of consolidation therapy with R (rituximab). After treatment, the patient's uterus was significantly smaller than before and there was no sign of a recurrence.
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7
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Matsas A, Christopoulos P, Karachalios C, Savranakis O, Marinos L, Vlahos NF, Panoskaltsis T. Primary follicular lymphoma of the uterine cervix: A case report. Oncol Lett 2023; 25:251. [PMID: 37153041 PMCID: PMC10161347 DOI: 10.3892/ol.2023.13837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/13/2023] [Indexed: 05/09/2023] Open
Abstract
Primary non-Hodgkin lymphoma of the uterine cervix is a rare clinical entity. The present case report describes an incidence of primary cervical follicular lymphoma, diagnosed during management of concurrent cervical intraepithelial neoplasia. The present case report outlines not only the necessity of adhering to guidelines regarding the management of abnormal cervical cytology, but also the importance of expert pathological review and the need for personalized management.
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Affiliation(s)
- Alkis Matsas
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
- Laboratory of Experimental Surgery and Surgical Research ‘N.S. Christeas’, National and Kapodistrian University of Athens Medical School, 11527 Athens, Greece
| | - Panagiotis Christopoulos
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
| | - Charalampos Karachalios
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
| | - Orestis Savranakis
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
| | - Leonidas Marinos
- Hematopathology Department, Evangelismos General Hospital, 10676 Athens, Greece
| | - Nikos F. Vlahos
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
| | - Theodoros Panoskaltsis
- Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, 11528 Athens, Greece
- Correspondence to: Professor Theodoros Panoskaltsis, Second Department of Obstetrics and Gynecology, Aretaieio University Hospital, National and Kapodistrian University of Athens Medical School, Vas. Sofias 76, 11528 Athens, Greece, E-mail:
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8
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Rajendran T, Kini JR, Prasad K. Primary Ovarian Non-Hodgkin's Lymphoma: An 18-year Retrospective Institutional Study and Review of Literature from India. Cureus 2023; 15:e40685. [PMID: 37485204 PMCID: PMC10357973 DOI: 10.7759/cureus.40685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Primary lymphomas of the female reproductive tract are rare and the ovarian extranodal presentation of non-Hodgkin's lymphoma (NHL) accounts for only 0.5% of all NHLs and 1.5% of all ovarian malignancies. METHODS We retrospectively reviewed the institutional medical oncology database for newly diagnosed NHL cases between 1999 and 2017. We aimed to study the clinical characteristics, pathology, and outcome of primary ovarian non-Hodgkin's lymphoma (NHL) cases presented to our institution. RESULTS We identified three patients (3.7% of extranodal NHLs and 0.85% of all NHL patients) with primary ovarian NHL from 350 NHL patient records. They underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by six to eight cycles of (rituximab, adriamycin, cyclophosphamide, vincristine, prednisolone (R-CHOP/CHOP), and they attained complete remission. CONCLUSION Given the heterogeneity of cancer incidence in India and the absence of state-wise cancer registries, our study argues a pressing need to develop a national representative registry for NHL for accurate incidence, mortality, and survival data. Additionally, fertility preservation is an important issue that must be discussed with women of fertile age and the parents of children.
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Affiliation(s)
- Tara Rajendran
- Department of General Medicine, Kasturba Medical College-Mangalore, Manipal Academy of Higher Education (MAHE-Manipal), Mangalore, IND
- Department of Music, Faculty of Fine Arts, Annamalai University, Chidambaram, IND
| | - Jyoti R Kini
- Department of Pathology, Kasturba Medical College-Mangalore, Manipal Academy of Higher Education (MAHE-Manipal), Mangalore, IND
| | - Krishna Prasad
- Department of General Medicine, Kasturba Medical College-Mangalore, Manipal Academy of Higher Education (MAHE-Manipal), Mangalore, IND
- Department of Medical Oncology, Mangalore Institute of Oncology, Mangalore, IND
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9
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Bourgioti C, Konidari M, Moulopoulos LA. Manifestations of Ovarian Cancer in Relation to Other Pelvic Diseases by MRI. Cancers (Basel) 2023; 15:cancers15072106. [PMID: 37046767 PMCID: PMC10093428 DOI: 10.3390/cancers15072106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Imaging plays a pivotal role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses. While epithelial ovarian cancer (EOC) has typical findings on MRI; there are several benign and malignant pelvic conditions that may mimic its appearance on imaging. Knowledge of the origin and imaging characteristics of a pelvic mass will help radiologists diagnose ovarian cancer promptly and accurately. Finally, in special subgroups, including adolescents and gravid population, the prevalence of various ovarian tumors differs from that of the general population and there are conditions which uniquely manifest during these periods of life.
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Affiliation(s)
- Charis Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
| | - Marianna Konidari
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
| | - Lia Angela Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vas. Sofias Ave., 11528 Athens, Greece
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10
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Saksena A, Jain A, Pack SD, Kim J, Lee I, Tyagi M, Xi L, Pittaluga S, Raffeld M, Jaffe ES. Follicle Center Lymphoma (FCL) of the Lower Female Genital Tract (LFGT): A Novel Variant of Primary Cutaneous Follicle Center Lymphoma (PCFCL). Am J Surg Pathol 2023; 47:409-419. [PMID: 36461146 PMCID: PMC9974907 DOI: 10.1097/pas.0000000000002003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Primary cutaneous follicle center lymphoma has been distinguished from nodal follicular lymphoma (FL) based on genomic and clinical features. The nature of other extranodal FLs is not well defined. We report 15 cases of follicle center lymphoma involving the lower female genital tract. Cases were evaluated using an immunohistochemical panel for B-cell lymphoma, B-cell clonality, fluorescence in situ hybridization for BCL2 gene rearrangement, and next-generation sequencing. All patients had localized disease with no evidence of bone marrow involvement. Most cases (12/15, 80%) had a follicular pattern, at least focally. Large centrocytes were a prominent feature leading to concern for diffuse large B-cell lymphoma by referring pathologists. Neoplastic cells were positive for CD20 and BCL-6, while BCL-2 was positive in 2/15 (13%) cases. Fluorescence in situ hybridization for BCL2 gene rearrangement was negative in 10/11 (91%) cases. Next-generation sequencing performed in 10 cases revealed TNFRSF14 as the most frequently mutated gene in 6/10 (60%) cases. No case had CREBBP or KMT2D mutations as seen in nodal FL. None of the patients had progressive disease with durable complete remission achieved in 10/12 (83%) cases. The median follow-up period was 7.8 years (range: 0.2 to 20.5 y) with a 5-year overall survival of 100%. We conclude that follicle center lymphoma of the lower female genital tract is a novel variant of primary cutaneous follicle center lymphoma. Despite a frequent component of large cells, it is characterized by localized disease and low risk for dissemination. Awareness and recognition are important to distinguish these lesions from aggressive B-cell lymphomas.
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Affiliation(s)
- Annapurna Saksena
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Ashish Jain
- CCR Collaborative Bioinformatics Resource (CCBR), CCR, NCI, Bethesda, MD
- Advanced Biomedical Computational Science, Frederick National Laboratory for Cancer Research, Frederick, MD
| | - Svetlana D. Pack
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Jung Kim
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Ina Lee
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Manoj Tyagi
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Liqiang Xi
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Stefania Pittaluga
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
| | - Elaine S. Jaffe
- Laboratory of Pathology, Center for Cancer Research (CCR), National Cancer Institute (NCI), NIH, Bethesda, MD
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11
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Peng F, Li J, Mu S, Qin Y, Ma J, Ai L, Hu Y. Epidemiological features for primary lymphoma of the female genital tract patients and development of a nomogram to predict survival. Ann Med 2022; 54:962-976. [PMID: 35416104 PMCID: PMC9009932 DOI: 10.1080/07853890.2022.2046289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary lymphoma of the female genital tract (PLFGT) is a sporadic extranodal lymphoma. Its epidemiology and prognosis are not fully recognized. Our study aimed to construct and validate prognostic nomograms for predicting survival for patients with PLFGT. METHODS Incidence rate from 1975 to 2017 and patients with PLFGT from 1975 to 2011 in the Surveillance, Epidemiology and End Results (SEER) database were retrospectively reviewed. The nomograms of overall survival (OS) and disease-specific survival (DSS) were established according to the multivariate Cox regression analyses. The concordance index (C-index) and calibration plots were used to demonstrate its robustness and accuracy. RESULTS A total of 617 PLFGT patients were identified. The overall incidence of PLFGT is 0.437/1,000,000 (adjusted to the US standard population in 2000) from 1975 to 2017. Age, histological subtype, Ann Arbor Stage, and therapeutic strategy were identified as independent prognostic factors for OS and DSS by multivariate Cox regression (p < .05). Nomograms to predict 1-, 5-, and 10-year OS and DSS were established. The C-index and calibration plots showed a good discriminative ability and an optimal accuracy of the nomograms. Patients were divided into three risk groups according to the model of OS. CONCLUSIONS The incidence of PLFGT has increased in the past 40 years, and the nomograms were developed and validated as an individualized tool to predict OS and DSS for all PLFGT patients and DLBCL patients. All patients are divided into three risk groups to assist clinicians to identify patients at high-risk and choose the optimal individualized treatments for patients.HighlightsThe incident of PLFGT and its subtypes were calculated and compared.Nomograms were constructed to predict the 1-, 5-, and 10-year OS and DSS.Patients are divided into the low-risk, medium-risk, and high-risk according total score of the nomogram.
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Affiliation(s)
- Fei Peng
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingwen Li
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shidai Mu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - You Qin
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiewen Ma
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lisha Ai
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, China
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12
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Usman A, Sultan A, Rehman S, Rehman A. Non-Hodgkin's Vaginal Lymphoma: A Rare Presentation. Cureus 2022; 14:e28364. [PMID: 36168387 PMCID: PMC9508324 DOI: 10.7759/cureus.28364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Vaginal non-Hodgkin's lymphoma (NHL) is a rare entity. We report a case of a 38-year-old lady who presented with complaints of lower abdominal pain for three to four months and vaginal bleeding for one month. Her examination under general anesthesia revealed a hard vaginal mass which was biopsied and immunohistochemistry was performed. Diagnosis of diffuse B‑cell NHL (DLBCL) was made. Imaging plays an important role to reach the diagnosis. Chemotherapy is the treatment of choice.
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13
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Aminimoghaddam S, Salarifar E, Noei Teymoordash S. Primary large B-cell lymphoma of the cervix: A case report and review of literature. Clin Case Rep 2022; 10:e05639. [PMID: 35356182 PMCID: PMC8955961 DOI: 10.1002/ccr3.5639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 03/03/2022] [Accepted: 03/12/2022] [Indexed: 12/02/2022] Open
Abstract
The primary diffuse large B-cell lymphoma (DLBCL) of the uterine cervix is extremely rare. In the present study, we described two cases of DLBCL of the uterine cervix in reproductive-aged women complaining of postcoital bleeding, recurrent vaginal discharge, and abnormal uterine bleeding.
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Affiliation(s)
- Soheila Aminimoghaddam
- Department of Obstetrics and GynecologyFaculty of MedicineIran University of Medical SciencesTehranIran
| | - Elnaz Salarifar
- Department of Obstetrics and GynecologyFaculty of MedicineIran University of Medical SciencesTehranIran
| | - Somayyeh Noei Teymoordash
- Department of Obstetrics and GynecologyFaculty of MedicineIran University of Medical SciencesTehranIran
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14
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Hamer J, Alazizi M, Tahmasebi F. An Unusual Case of Chronic Lymphocytic Leukaemia Involving the Cervix. Cureus 2022; 14:e21823. [PMID: 35291544 PMCID: PMC8896842 DOI: 10.7759/cureus.21823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic lymphocytic leukaemia (CLL) is a malignant monoclonal expansion of B lymphocytes, with accumulation of abnormal lymphocytes in the blood, bone marrow, spleen, lymph nodes and liver. It is mainly a disease of the elderly population. Though extra-nodal involvement is common, cervical and vulvovaginal involvement by CLL is particularly uncommon. In this case report, we discuss the case of cervical involvement of CLL in an 84-year-old patient who presented to rapid-access gynaecological clinic following concerns of persistent postmenopausal bleeding. Previously the patient was known to haematology with a well-controlled diagnosis of CLL since 2007. The initial examination was significant for an enlarged, irregular cervix, whereby a punch biopsy was then obtained. Histological analysis revealed evidence of CLL within the cervix.
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15
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Chuang AY, Watkins JC, Young RH, Lerwill MF. Lobular Carcinoma of the Breast Metastatic to the Ovary: A Clinicopathologic Study of 38 Cases. Am J Surg Pathol 2022; 46:179-189. [PMID: 34931622 DOI: 10.1097/pas.0000000000001812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We evaluated the clinicopathologic features of 38 cases of metastatic lobular (n=33) or predominantly lobular (n=5) carcinoma involving the ovary. The patients were from 39 to 91 years of age (mean: 53 y). In 2 cases, the breast primary and ovarian metastasis were diagnosed synchronously, and in 5, the breast primary was only discovered after the metastatic carcinoma in the ovary was found. In the majority of cases (79%), both ovaries were involved; the mean ovarian tumor size was 5.9 cm. The ovarian tumors demonstrated a range of architectural patterns including macronodular (71%), diffuse/solid growth (87%), single-cell infiltration (87%), cords (74%), and small nests/clusters (50%). Nine cases demonstrated focal signet ring cell morphology. The associated stromal reaction ranged from none to marked, with almost half of cases demonstrating a marked stromal response, largely prominent sclerosis. A variety of neoplasms, most typically sex cord-stromal tumors, lymphoma/leukemia, and desmoplastic small round cell tumor, may enter the differential. In addition to the obvious help afforded in most cases by the clinical history, a combination of judicious sampling, particularly to unearth the delicate cords or single-cell growth of lobular carcinoma, appropriate consideration of the cytologic features of the neoplastic cells, and immunohistochemistry can resolve the diverse issues in differential diagnosis that may arise.
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Affiliation(s)
- Ai-Ying Chuang
- Department of Pathology, Koo Foundation Sun Yat-Sen Cancer Center
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jaclyn C Watkins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert H Young
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Melinda F Lerwill
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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16
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Albuquerque KS, Zoghbi KK, Gomes NBN, Libânio BB, Souza e Silva TX, de Araújo EM, Lewin F, Pedroso MHNI, Torres US, D'Ippolito G, Racy DJ, Bernardo GCO. Vaginal cancer: Why should we care? Anatomy, staging and in-depth imaging-based review of vaginal malignancies focusing on MRI and PET/CT. Clin Imaging 2022; 84:65-78. [DOI: 10.1016/j.clinimag.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 01/06/2022] [Accepted: 01/20/2022] [Indexed: 11/03/2022]
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17
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Du E, Qu X, Xu W, Lu H. Primary female genital system lymphoma complicated by a recurrent mucinous borderline ovarian tumor: a case report and review of the literature. BMC Womens Health 2021; 21:420. [PMID: 34922516 PMCID: PMC8684173 DOI: 10.1186/s12905-021-01568-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background Primary female genital system lymphoma (PFGSL) is an infrequent entity. All genital organs may be affected, and most PFGSLs are localized to the cervix, uterine body, and ovaries. The clinical manifestations are nonspecific, which complicates a timely diagnosis. We report an unexpected case of PFGSL and discuss the disease characteristics by reviewing the literature. Case presentation A 48-year-old G3/P2 woman presented to the Department of Gynecology with a physical examination. Ultrasound examination and CT revealed pelvic masses. The woman underwent surgical treatment because of the pelvic masses and underwent a hysterectomy for a recurrent mucinous borderline ovarian tumor. However, the results of the postoperative pathological examination showed diffuse large B-cell lymphoma of the endometrium. After four courses of chemotherapy, the woman was in good condition. The clinical manifestations were nonspecific, which made a timely diagnosis complex. Conclusion This case highlights the importance of the difficulty in detecting early PFGSL early and how easily nonspecific manifestations can be ignored. It may lead to missing the best time for early treatment.
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Mega J, O'Brien V, Hammond N, Aeum J, Bunch K. A rare case of metastatic uterine lymphoma in a renal transplant patient. Radiol Case Rep 2021; 16:3675-3679. [PMID: 34630799 PMCID: PMC8493514 DOI: 10.1016/j.radcr.2021.08.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
Primary and disseminated lymphoma of the female reproductive tract are rare types of lymphoma. However, in the setting of solid organ transplant, recipients have an approximately doubled risk of acquiring and dying from malignancy. Multiple treatment modalities are available for post-transplant lymphoproliferative diseases (PTLD), including chemotherapy, radiotherapy, surgery, and immunosuppression radiotherapy. We report a case of a 61-year-old female with multifocal nodal diffuse large B-cell lymphoma and a history of a renal transplant secondary to IgA nephropathy who developed metastatic diffuse large B-cell lymphoma to the uterus. While the baseline incidence of PTLD is elevated when compared with lymphoma in the general population, metastatic uterine lymphoma is rare. Awareness of reproductive organ involvement by lymphomas and increased malignancy risk in organ transplant patients are important considerations for diagnostic evaluation, including radiologic assessment.
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Affiliation(s)
- James Mega
- Department of Radiology, Tripler Army Medical Center, 1 Jarrett White Rd. Honolulu, HI 96859 USA
| | - Victoria O'Brien
- Department of Obstetrics and Gynecology, Tripler Army Medical Center, 1 Jarrett White Rd. Honolulu, HI 96859 USA
| | - Nicholas Hammond
- Department of Radiology, Tripler Army Medical Center, 1 Jarrett White Rd. Honolulu, HI 96859 USA
| | - Judy Aeum
- Department of Pathology, Tripler Army Medical Center, 1 Jarrett White Rd. Honolulu, HI 96859 USA
| | - Kristen Bunch
- Department of Obstetrics and Gynecology, Tripler Army Medical Center, 1 Jarrett White Rd. Honolulu, HI 96859 USA
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Ensor AM, Sanchez CG, Ensor JE, Anand K. Primary diffuse large B-cell lymphoma of the uterus: A SEER database analysis. Medicine (Baltimore) 2021; 100:e27359. [PMID: 34622835 PMCID: PMC8500583 DOI: 10.1097/md.0000000000027359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
Uterine diffuse large B-cell lymphoma (DLBCL) is a rare clinical condition. Most studies for uterine DLBCL are derived from case reports and series. Our main objective was to present a new case while also investigating the demographic, clinical characteristics, and survival of women with primary uterine DLBCL as compared to non-uterine DLBCL using the Surveillance, Epidemiology, and End Results incidence database. We queried the Surveillance, Epidemiology, and End Results database for women aged 18 years or older with a diagnosis of primary DLBCL from 1975 to 2017. The most common site of primary uterine DLBCL is the cervix uteri not otherwise specified, followed by endometrium, uterus not otherwise specified, corpus uteri, myometrium and isthmus uteri. Non-uterine DLBCL cases tend to be older than uterine DLBCL cases. Uterine DLBCL is most common among women aged 40 to 64 years. Patients with uterine DLBCL showed greater survival than non-uterine DLBCL patients, and patients treated in the rituximab era also exhibited a survival benefit. Both the elderly and African American cohorts experienced worse overall survival.
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Affiliation(s)
- Allyne M. Ensor
- William Carey University College of Medicine, Hattiesburg, MS
| | | | - Joe E. Ensor
- Houston Methodist Cancer Center, Houston, TX
- Houston Methodist Research Institute, Houston, TX
| | - Kartik Anand
- Callahan Cancer Center, Great Plains Health, North Platte, NE
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20
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Rastegar S, Heller DS. Nonsquamous Lesions of the Vulvar Skin and Subcutaneous Tissue: A Review (Part 1). J Low Genit Tract Dis 2021; 25:303-311. [PMID: 34542086 DOI: 10.1097/lgt.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This article aimed to review "nonsquamous lesions of the vulvar skin and subcutaneous tissue" clinically and pathologically, based on the fifth edition of the World Health Organization tumor classification. MATERIALS AND METHODS A database search of PubMed and Google Scholar was performed between 1970 and 2021, using the search terms "vulva," "lower genital tract," and "nonsquamous lesions." The search was limited to "humans," "gynecopathology," and "dermatopathology." Full article texts were reviewed. Reference lists were screened for additional articles. We excluded articles written in the non-English language and abstracts. RESULTS A list of 600 articles was identified. Another screening identified 68 articles for clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue. In the first part of this review, we cover 5 major groups of nonsquamous lesions of the vulvar skin and subcutaneous tissue including (1) glandular tumors and cysts, (2) adenocarcinomas of other types, (3) germ cell tumors of the vulva, (4) neuroendocrine neoplasia, and (5) hematolymphoid hyperplasia and neoplasia. The rest of the major topics including mesenchymal tumors of the lower genital tract, melanocytic lesions, and metastasis will be discussed in the second part of this review. CONCLUSIONS Clinicopathological features of nonsquamous lesions of the vulvar skin and subcutaneous tissue as categorized by the updated World Health Organization classification are presented.
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Affiliation(s)
- Shima Rastegar
- Department of Pathology, Immunology and Laboratory Medicine, Rutgers-New Jersey Medical School, Newark, NJ
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21
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Menon PD, Tariq H, Forker C, Nazarullah A. Diagnosis of uterine lymphoma on cervical pap smear: Case report and review of literature. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2020.200466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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22
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Zhou Y, Zhang C, Gong Y, Yang L, Wang Y. Primary diffuse large B-cell lymphoma of the fallopian tube treated with a combination of surgery and chemotherapy: Case report. Medicine (Baltimore) 2021; 100:e24049. [PMID: 33546005 PMCID: PMC7837899 DOI: 10.1097/md.0000000000024049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Ye Zhou
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining Medical University
| | - Chao Zhang
- School of Clinical Medicine Jining Medical University, Shandong, China
| | - Yingying Gong
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining Medical University
| | - Linqing Yang
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining Medical University
| | - Yunfei Wang
- Department of Gynecology, Affiliated Hospital of Jining Medical University, Jining Medical University
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23
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Taylor EC, Irshaid L, Mathur M. Multimodality Imaging Approach to Ovarian Neoplasms with Pathologic Correlation. Radiographics 2020; 41:289-315. [PMID: 33186060 DOI: 10.1148/rg.2021200086] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Ovarian neoplasms can be categorized on the basis of histopathologic features into epithelial surface cell tumors, germ cell tumors, sex cord-stromal tumors, and metastases. While their imaging appearance is often nonspecific, it closely parallels the gross pathologic appearance, and radiologic-pathologic correlation is helpful to aid in a deeper understanding of the subtypes. Epithelial cell neoplasms are the most common category, and they can be benign, borderline, or malignant. Specific subtypes include serous (most common), mucinous, seromucinous, endometrioid, clear cell, Brenner, and undifferentiated. High-grade serous cystadenocarcinoma accounts for the majority of malignant ovarian tumors and the most ovarian cancer deaths. While serous neoplasms are often unilocular and bilateral, mucinous neoplasms are larger, unilateral, and multilocular. Solid components, thickened septa, and papillary projections, particularly with vascularity, indicate borderline or malignant varieties. Endometrioid and clear cell carcinomas can arise within endometriomas. Fibrous tumors (cystadenofibroma, adenofibroma, fibroma or fibrothecoma, and Brenner tumors) demonstrate low T2-weighted signal intensity of their solid components, while teratomas contain lipid. The nonspecific imaging appearance of additional malignant ovarian germ cell tumors can be narrowed with tumor marker profiles. Sex cord-stromal tumors are often solid, and secondary signs from their hormonal secretion can be a clue to their diagnosis. The authors review the anatomy of the ovary and distal fallopian tube, the proposed origins of the histologic subtypes of tumors, the clinical features and epidemiology of ovarian neoplasms, and the applications of US, CT, and MRI in imaging ovarian neoplasms. The main focus is on the radiologic and pathologic features of the multiple ovarian neoplasm subtypes. An algorithmic approach to the diagnosis of ovarian neoplasms is presented. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Erin C Taylor
- From the Department of Radiology and Biomedical Imaging (E.C.T., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Lina Irshaid
- From the Department of Radiology and Biomedical Imaging (E.C.T., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Radiology and Biomedical Imaging (E.C.T., M.M.) and Department of Pathology (L.I.), Yale School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
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24
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Del M, Angeles MA, Syrykh C, Martínez-Gómez C, Martínez A, Ferron G, Gabiache E, Oberic L. Primary B-Cell lymphoma of the uterine cervix presenting with right ureter hydronephrosis: A case report. Gynecol Oncol Rep 2020; 34:100639. [PMID: 32995453 PMCID: PMC7508993 DOI: 10.1016/j.gore.2020.100639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 11/18/2022] Open
Abstract
Primary lymphoma of the uterine cervix is a very infrequent disease, usually affecting perimenopausal women. Symptoms are very similar to other gynecological malignancies, but treatment and prognosis completely differ, as most of these patients have a better survival. This condition has to be suspected in women with recent normal Pap smear test, rapidly growing tumor and initially non-contributory biopsies. We report a case of primary diffuse large-B-cell lymphoma of the uterine cervix mimicking a locally advanced cervical cancer with right ureter hydronephrosis at diagnosis. She was medically managed with a combination of rituximab and chemotherapy with cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone, associated to methotrexate for central nervous system prophylaxis. We will discuss about the role of combined treatments with surgery and radiotherapy, and the fertility sparing management in young women.
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Affiliation(s)
- Mathilde Del
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse (IUCT) – Oncopole, Toulouse, France
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse (IUCT) – Oncopole, Toulouse, France
| | - Charlotte Syrykh
- Department of Pathology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse (IUCT) – Oncopole, Toulouse, France
| | - Carlos Martínez-Gómez
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse (IUCT) – Oncopole, Toulouse, France
- INSERM CRCT Team 1, Tumor Immunology and Immunotherapy, Toulouse, France
| | - Alejandra Martínez
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse (IUCT) – Oncopole, Toulouse, France
- INSERM CRCT Team 1, Tumor Immunology and Immunotherapy, Toulouse, France
| | - Gwénaël Ferron
- Department of Surgical Oncology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse (IUCT) – Oncopole, Toulouse, France
- INSERM CRCT Team 19, ONCOSARC – Oncogenesis of sarcomas, Toulouse, France
| | - Erwan Gabiache
- Department of Nuclear Medicine, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse (IUCT) – Oncopole, Toulouse, France
| | - Lucie Oberic
- Department of Hematology, Institut Claudius Regaud – Institut Universitaire du Cancer de Toulouse (IUCT) – Oncopole, Toulouse, France
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25
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Mohanlal RD. Endometrial sampling at an academic hospital in South Africa: Histological findings, lessons learnt and interesting surprises. Afr J Lab Med 2020; 9:1038. [PMID: 33102167 PMCID: PMC7565020 DOI: 10.4102/ajlm.v9i1.1038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 05/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Outpatient sampling is used to investigate endometrial pathology. Little is known about practice habits and local failure rates at Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa. Objective This study assessed the frequency of samples that showed no or limited histological representation of endometrium, and described demographic and pathological features. Methods All endometrial sample histology reports from the National Health Laboratory Services at the hospital from 01 July 2013 to 31 May 2017 were retrieved by searching the laboratory’s information system. Clinical variables (age, menopausal state, indication for biopsy, endometrial thickness on ultrasound) and pathological findings (macroscopic amount of tissue, histological diagnosis, microscopic presence of endometrial tissue) were extracted and statistically analysed. Results A total of 1926 samples were included, 91% of which were submitted for abnormal or postmenopausal bleeding. No endometrium was observed in 25% of samples and 13% showed limited endometrium. Benign diagnoses (86%) were most common, with proliferative or secretory changes, endometrial polyps and endometritis accounting for most of these. Associations between the amount of sample received and the presence of endometrial tissue (p ≤ 0.001) and benign versus malignant diagnoses (p ≤ 0.001) were noted. The greater the endometrial thickness, the greater the likelihood of obtaining more sample (bulky vs scant p < 0.001) and making a malignant versus benign diagnosis (p = 0.005). Conclusion These findings are in keeping with literature outside Africa. Histology reports should be explicit when terms such as ‘inadequate’ or ‘insufficient’ are used, in order to facilitate clinical decision-making.
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Affiliation(s)
- Reena D Mohanlal
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,National Health Laboratory Services, Chris Hani Baragwanath Laboratory, Johannesburg, South Africa
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26
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Extramedullary Leukemia, Presenting at the Cervix of the Uterus. Case Rep Obstet Gynecol 2020; 2020:8492036. [PMID: 32934855 PMCID: PMC7479477 DOI: 10.1155/2020/8492036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 08/04/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022] Open
Abstract
Extramedullary relapse of leukemia is encountered more often than in the past. The reason is that leukemia survival rates increase with improved treatment schemes. We present a rare case of involvement of the cervix of the uterus in an adult B Acute Lymphocytic Leukemia (B-ALL) survivor. Relapses affect various organs but rarely the female genital tract. Nevertheless, in this case, a woman with a history of induced amenorrhea due to treatment for leukemia presented to the gynecologist because of vaginal spotting. Colposcopy evaluation of the vagina/cervix, sonography and cytological and histological sampling established the diagnosis of leukemia relapse in the cervix of the uterus. Under these circumstances, our study highlights the rare extramedullary presentation of leukemia in the cervix of the uterus of a young lady considered to be disease-free and listed for bone marrow transplantation. In this rare case of relapse in the cervix of the uterus, Pap smears alarmed physicians, and radiology examinations assisted the diagnostic workup. Still, only biopsy, microscopic evaluation, and immunohistochemistry studies established the exact diagnosis. Prognosis in the situation of extramedullary disease relapse in the female genital tract was poor, but gynecologists' high suspicion led to a prompt diagnosis. Survival is in general limited, but together with high suspicion, multidisciplinary team involvement is imperative to improve the reduced chances of survival.
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27
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Tan A, Bieber AK, Stein JA, Pomeranz MK. Diagnosis and management of vulvar cancer: A review. J Am Acad Dermatol 2019; 81:1387-1396. [PMID: 31349045 DOI: 10.1016/j.jaad.2019.07.055] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/12/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022]
Abstract
Vulvar malignancies represent a serious gynecologic health concern, especially given the increasing incidence over the past several decades. Squamous cell carcinoma and melanoma are common subtypes, although other neoplasms, such as basal cell carcinoma and Paget disease of the vulva, might be seen. Many vulvar cancers are initially misdiagnosed as inflammatory conditions, delaying diagnosis and worsening prognosis. It is essential that dermatologists are familiar with characteristic findings for each malignancy to ensure appropriate diagnosis and management. Herein, we review the unique epidemiologic and clinical characteristics of each major vulvar malignancy, as well as discuss their respective prognoses and current management recommendations.
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Affiliation(s)
- Andrea Tan
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Amy K Bieber
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Jennifer A Stein
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Miriam K Pomeranz
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York.
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28
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Contreras-Chavez P, Aliaga R, Samee M, Anampa-Guzmán A. Primary Vaginal Non-Hodgkin Lymphoma. Cureus 2018; 10:e3713. [PMID: 30788202 PMCID: PMC6373882 DOI: 10.7759/cureus.3713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022] Open
Abstract
Non-Hodgkin lymphoma (NHL) is a type of blood cancer and 25% of NHL patients present with a primary extranodal tumor. Primary NHL of the vagina is extremely rare with only a few cases reported. We present the case of a 79-year-old, grand multipara, Peruvian woman with an eleven-month history of symptoms of pelvic and vaginal pain and vaginal bleeding. Vaginal examination revealed an exophytic tumor that involved the labia, right vaginal wall, cervix, parametrium, and pelvic bone. A computed tomography (CT) image showed a 10 x 10 x 9-cm solid tumor in the pelvic cavity with irregular edges in the pelvic floor, parametrium, and the perineal soft tissues. Bilateral pelvic and inguinal adenomegalies were found. No signs of metastases were found. Marrow and bone biopsy studies were negative. The diagnosis was NHL type diffuse large B-cell lymphoma (DLBCL) of vagina stage one. The patient was treated with six courses of CHOP-R (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab). She showed a complete response and remained in remission in follow-up control visits. NHL of the female genital tract is rare. CHOP-R is the first line of treatment for this type of cancer. However, less is known about the follow-up protocol and relapse management. Vaginal lymphoma has an extremely low prevalence, and collaborative studies are required to study the same.
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Affiliation(s)
| | - Rolig Aliaga
- Oncology, Hospital Nacional Arzobispo Loayza, Lima, PER
| | - Mohammed Samee
- Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, USA
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29
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Ishii Y, Fujisawa S, Ando T, Suzuki T, Ishiyama Y, Kishimoto K, Hattori Y, Nakajima Y, Miyazaki T, Takasaki H, Matsumoto K, Koharazawa H, Taguchi J, Fujimaki K, Sakai R, Nakajima H. Primary uterine lymphoma: The Yokohama Cooperative Study Group for Hematology (YACHT) study. Asia Pac J Clin Oncol 2018; 14:e455-e459. [PMID: 29984481 DOI: 10.1111/ajco.13049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
AIM Primary malignant lymphomas arising from the female genital tract are very rare, with an incidence rate of 0.5%. Because of its rarity, its clinical characteristics, prognosis and optimal treatment are still unclear. Here, we retrospectively evaluated female patients with uterine lymphoma. METHODS Between January 2000 and October 2016, 4362 patients were newly diagnosed with malignant lymphoma by the participating institutions of YACHT. Among these 4362 patients, we retrospectively evaluated 14 adult patients with primary uterine lymphoma. RESULTS The median follow up time was 41 months. The median age at diagnosis was 68 years. Of 14 patients, 10 (72%) were diagnosed with diffuse large B-cell lymphoma. Seven patients presented with vaginal bleeding and three with abdominal pain. Eleven patients (79%) had advanced stages at diagnosis. Three patients (21%) had ovarian involvement and 2 (14%) had vaginal involvement. Induction chemotherapy regimens were R-CHOP in seven patients (50%), CHOP in three (21%) and other regimens in four (29%). Among 14 patients, 12 patients (86%) achieved a complete response and 2 (14%) experienced disease progression. Three patients (21%) showed relapse. Five patients (36%) died because of malignant lymphoma. The 3-year overall survival rate was 57.9%. Soluble interleukin-2 receptor levels > 5000 U/mL, anemia, a bulky mass and the presence of > 1 extranodal sites, B symptom at diagnosis were associated with a poor prognosis. CONCLUSION Female genital lymphoma is very rare, and further study of more cases is warranted.
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Affiliation(s)
- Yoshimi Ishii
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Fujisawa
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Taiki Ando
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | - Taisei Suzuki
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Kumiko Kishimoto
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Japan
| | - Yukako Hattori
- Department of Hematology, Fujisawa City Hospital, Fujisawa, Japan
| | - Yuki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takuya Miyazaki
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan
| | | | - Kenji Matsumoto
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan
| | | | - Jun Taguchi
- Department of Hematology, Shizuoka Red Cross Hospital, Otemachi, Japan
| | | | - Rika Sakai
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan
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Geller S, Pitter K, Moskowitz A, Horwitz SM, Yahalom J, Myskowski PL. Treatment of Vulvar Mycosis Fungoides Tumors With Localized Radiotherapy. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e279-e281. [PMID: 29752211 DOI: 10.1016/j.clml.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/27/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Shamir Geller
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY.
| | - Ken Pitter
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Alison Moskowitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY
| | - Steven M Horwitz
- Lymphoma Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia L Myskowski
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York, NY
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31
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Koyanagi T, Kondo H, Toyama A, Ando M, Imaoka S, Inamura M, Yamamoto H, Nakamura S, To Y, Fukami T, Goto M, Tsujioka H, Eguchi F. Malignant lymphoma of the uterine cervix presumptively diagnosed by Pap smear: A case report. Oncol Lett 2018; 15:6678-6680. [PMID: 29725409 DOI: 10.3892/ol.2018.8146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 02/21/2018] [Indexed: 11/06/2022] Open
Abstract
Malignant lymphoma of the uterine cervix is exceedingly rare and is difficult to diagnose by cervical cytology. The current study presents a case of malignant lymphoma of the uterine cervix that was presumptively diagnosed by cervical cancer screening in which the patient had no clinical symptoms. The anterior lip of the uterine cervix was occupied by a macroscopic hemorrhagic tumor. The obtained tumor cells exhibited typical cytological features of malignant lymphoma and were positive for CD20. The final diagnosis was diffuse large B cell lymphoma of the uterine cervix, stage IIEA (Ann Arbor classification). The patient received 6 courses of R-CHOP chemotherapy and achieved complete remission. Despite its rarity, the possibility of malignant lymphoma should be considered while screening for cervical cancers using Pap smears. The Pap test screening may be useful for the early diagnosis of malignant lymphoma of the uterine cervix in certain cases. By reaching a rapid and accurate diagnosis, immediate treatment may be initiated and surgery may be avoided.
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Affiliation(s)
- Takahiro Koyanagi
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Haruhiko Kondo
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Atsushi Toyama
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Miho Ando
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Sakiko Imaoka
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Masayo Inamura
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Hiroko Yamamoto
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Sumie Nakamura
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Yoko To
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Tatsuya Fukami
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Hiroshi Tsujioka
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Fuyuki Eguchi
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
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A Case of Primary Uterina Lymphoma Presenting with Bleeding, Pelvic Pain, and Dysmenorrhea. Case Rep Obstet Gynecol 2018; 2018:5065738. [PMID: 29607236 PMCID: PMC5828537 DOI: 10.1155/2018/5065738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/26/2017] [Indexed: 11/19/2022] Open
Abstract
Primary non-Hodgkin's lymphoma (NHL) can arise from lymphatic cells located in solid organs (extranodal) and it accounts for 25 to 35% of all NHL. Primary lymphoma on the female genital tract (PLFGT) is a rare disease, comprising 0.2 to 1.1% of all extranodal lymphomas in the female population. In this paper, the authors report an extremely rare case of a 48-year-old woman who exhibited an abnormal uterine bleeding, pelvic pain, and dysmenorrhea history. The transvaginal ultrasound showed an anteverted uterus measuring 153 cm3 in volume, with intramural leiomyomas. She underwent a total laparoscopic hysterectomy with bilateral salpingectomy. The histologic evaluation of the specimen showed a follicular lymphoma with diffuse pattern in the endometrium. This report illustrates the difficulty in the diagnosis of primary lymphomas of the female genital tract.
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33
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Wang F, Jing X, Liu B, Meng X, Sun X, Gao Y, Wang L, Fu Z. Primary non-Hodgkin's lymphoma of the vagina: A case report. Oncol Lett 2018; 15:3504-3507. [PMID: 29556272 PMCID: PMC5844002 DOI: 10.3892/ol.2018.7805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/07/2017] [Indexed: 12/23/2022] Open
Abstract
Primary non-Hodgkin's lymphoma (NHL) of the vagina is uncommon. The present case study reports the case of a 54-year-old female with a palpable mass between the rectum and vagina. The patient presented with symptoms consistent with vaginal cancer but lacked any of the ‘B’ symptoms often associated with systemic lymphoma, including fever, weight loss, night sweats and fatigue. The mass was resected under anesthesia. Immunohistochemistry and biopsy confirmed diffuse large B-cell NHL (DLBCL). Following surgery, six cycles of chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone were administered. Subsequently, a vertebral body metastasis was observed using a computed tomography scan and whole-body bone imaging. The patient received palliative radiation for the vertebral body metastasis. Additionally, the available literature was reviewed in order to further characterize this rare disease.
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Affiliation(s)
- Feng Wang
- School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong 250200, P.R. China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
| | - Xuquan Jing
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
| | - Bo Liu
- Department of Medical Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
| | - Xindong Sun
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
| | - Yongsheng Gao
- Department of Pathology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
| | - Linlin Wang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
| | - Zheng Fu
- Department of Computed Tomography, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong 250117, P.R. China
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34
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35
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Lee LY, Namuduri R, Chan MMF, Quek JKS, Koh MJA. Epstein-Barr virus positive diffuse large B-cell lymphoma presenting with vaginal sloughing and ulcerated skin nodule. J Cutan Pathol 2017; 45:162-166. [PMID: 29086996 DOI: 10.1111/cup.13074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 08/18/2017] [Accepted: 10/26/2017] [Indexed: 01/17/2023]
Abstract
Malignant lymphomas presenting in the female genital tract are extremely rare. We report a case of Epstein-Barr virus associated diffuse large B-cell lymphoma of the genital tract and skin in a 60-year-old woman on long-term azathioprine.
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Affiliation(s)
- Lynette Y Lee
- Dermatology Service, KK Women's and Children's Hospital, Singapore
| | - Rama Namuduri
- Department of Obstetrics and Gynecology, KK Women's and Children's Hospital, Singapore
| | | | - Jeffrey K S Quek
- Department of Haematology, Singapore General Hospital, Singapore
| | - Mark J-A Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore
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36
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Nasioudis D, Kampaktsis PN, Frey M, Witkin SS, Holcomb K. Primary lymphoma of the female genital tract: An analysis of 697 cases. Gynecol Oncol 2017; 145:305-309. [PMID: 28284518 DOI: 10.1016/j.ygyno.2017.02.043] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Primary lymphoma of the female genital tract (PLFGT) is a rare entity. The aim of this population-based study was to elucidate the clinico-pathological, demographic characteristics and survival of women with PLFGT. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results database was accessed and cases of PLFGT diagnosed between 1988 and 2012 were identified. Five-year overall (OS) and cancer-specific (CSS) survival rates were calculated with the Kaplan-Meier method. The influence of demographic and clinical parameters on survival was examined with the log-rank test. Factors independently associated with cancer-specific mortality were evaluated with a Cox proportional hazard model. RESULTS A total of 697 women with PLFGT were identified with a median age of 54years. The most prevalent histological subtypes were diffuse large B-cell (59.8%) and follicular (11.9%) lymphoma. Tumors were most commonly located in the ovary (37%), cervix (21.4%), and uterus (16.5%). According to the Ann Arbor staging system, 42.6% and 17.9% of cases had stage I and stage II disease, respectively. Cancer-directed surgery (CDS) was performed in the majority of cases (62.8%). Five-year OS and CSS were 70.2% and 75.2% respectively. Localized disease, premenopausal age and follicular histology were associated with superior cancer-specific mortality while CDS did not confer any mortality benefit. CONCLUSIONS This is the largest cohort of PLFGT presented in literature. While in our study surgical treatment was not associated with improved outcomes, larger multi-institutional studies should address the optimal management of women with PLFGT.
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Affiliation(s)
- Dimitrios Nasioudis
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA; Surgery Working Group, Society of Junior Doctors, Athens, Greece.
| | - Polydoros N Kampaktsis
- Surgery Working Group, Society of Junior Doctors, Athens, Greece; Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Melissa Frey
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Steven S Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
| | - Kevin Holcomb
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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37
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Sasikumar A, Joy A, Pillai MRA, Thomas B. 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scan in an Unusual Case of Lymphoma with Secondary Involvement of Uterine Cervix Presenting as a Pathological Fracture. Indian J Nucl Med 2017; 32:54-56. [PMID: 28242988 PMCID: PMC5317073 DOI: 10.4103/0972-3919.198483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 48-year-old female presented with a pathological fracture of the right femur. 99mTc methylene diphosphonate bone scan revealed multiple areas of increased osteoblastic activity consistent with metastatic disease. Serum electrophoresis revealed monoclonal gammopathy. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan revealed metabolically active lesions in bulky uterine cervix and osteolytic skeletal lesions. Unusual pattern of FDG uptake in uterine cervix and osteolytic skeletal lesions warranted a biopsy of the uterine cervix which revealed diffuse large B-cell lymphoma. 18F-FDG PET/CT scan helped in guiding the site of biopsy to reach a final diagnosis in this unusual case of lymphoma with a secondary involvement of uterine cervix presenting as a pathological fracture.
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Affiliation(s)
- Arun Sasikumar
- Department of Nuclear Medicine and PET/CT, KIMS-DDNMRC, KIMS Hospital, Thiruvananthapuram, Kerala, India
| | - Ajith Joy
- Department of Nuclear Medicine and PET/CT, KIMS-DDNMRC, KIMS Hospital, Thiruvananthapuram, Kerala, India
| | - M R A Pillai
- Department of Nuclear Medicine and PET/CT, KIMS-DDNMRC, KIMS Hospital, Thiruvananthapuram, Kerala, India
| | - Boben Thomas
- Department of Medical Oncology, KIMS Hospital, Thiruvananthapuram, Kerala, India
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38
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Rohena-Quinquilla IR, Lattin GE, Wolfman D. Imaging of Extranodal Genitourinary Lymphoma. Radiol Clin North Am 2017; 54:747-64. [PMID: 27265606 DOI: 10.1016/j.rcl.2016.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The genitourinary (GU) system is commonly affected by disseminated lymphoma. Rarely, lymphoma can originate from and remain localized to one of the GU organs and thus presents as primary extranodal disease. Up to 40% of lymphomas present as extranodal disease, with only 3% having the GU system as the primary site of involvement. This article describes and correlates the radiologic and pathologic features of extranodal lymphomatous disease affecting the GU system with specific focus on the kidneys, adrenal glands, testicles, and ovaries. Lymphoma of the uterine body and cervix, external female genitalia, urinary bladder, and prostate gland is briefly discussed.
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Affiliation(s)
- Iván R Rohena-Quinquilla
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Radiology, Martin Army Community Hospital, 6600 Van Aalst Boulevard, Fort Benning, GA 31905-5637, USA
| | - Grant E Lattin
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; American Institute for Radiologic Pathology, 1010 Wayne Avenue, Suite 320, Silver Spring, MD 20910, USA
| | - Darcy Wolfman
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; American Institute for Radiologic Pathology, 1010 Wayne Avenue, Suite 320, Silver Spring, MD 20910, USA; Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814, USA.
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39
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Yang G, Deisch J, Tavares M, Haixia Q, Cobb C, Raza AS. Primary B-cell lymphoma of the uterine cervix: Presentation in Pap-test slide and cervical biopsy. Diagn Cytopathol 2016; 45:235-238. [PMID: 27863160 DOI: 10.1002/dc.23627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 10/02/2016] [Accepted: 10/12/2016] [Indexed: 11/12/2022]
Abstract
This case involved a 69-year-old female who presented with irritative urinary voiding. Imaging studies showed an 18-cm uterine mass centering on the cervix and extending into the bladder. The Pap test slide demonstrated necrotic background and degenerative changes in single and grouped atypical "small round blue cells" with high nuclear/cytoplasm ratio, scant cytoplasm, and hyperchromatic focally cleaved nuclei with occasional nuclear membrane "snout projections." Cervical biopsies showed similar findings. The tumor cells were positive for CD45, CD20, and PAX-5, and negative with epithelial, neuroendocrine, and muscle markers. A Ki-67 immunostain showed a markedly elevated proliferative index and the MUM1 stain was diffusely positive. Molecular study identified clonal immunoglobulin heavy chain gene rearrangement. Owing to its rarity, cervical lymphoma may sometimes be confused with other types of malignant neoplasms or inflammatory processes. Therefore, it is important to recognize the cytological features of cervical lymphomas and be aware of the potential diagnostic pitfalls for timely diagnosis and therapy. Diagn. Cytopathol. 2017;45:235-238. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Guang Yang
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, California
| | - Jeremy Deisch
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, California
| | - Margaret Tavares
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, California
| | - Qin Haixia
- Department of Medicine, Loma Linda University Medical Center, Loma Linda, California
| | - Camilla Cobb
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, California
| | - Anwar S Raza
- Department of Pathology, Loma Linda University Medical Center, Loma Linda, California
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40
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Ainsworth A, Wood A, Kurtin P, Burnett T. An unusual case of abnormal uterine bleeding due to classical Hodgkin lymphoma identified by endometrial biopsy. Int J Gynaecol Obstet 2016; 135:331. [PMID: 27609742 DOI: 10.1016/j.ijgo.2016.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 06/30/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Alessandra Ainsworth
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Adam Wood
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Paul Kurtin
- Department of Laboratory Medicine and Pathology, Division of Hematopathology, Mayo Clinic, Rochester, MN, USA
| | - Tatnai Burnett
- Department of Obstetrics and Gynecology, Division of Minimally Invasive Gynecology, Mayo Clinic, Rochester, MN, USA.
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41
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Suh CH, Tirumani SH, Keraliya A, Kim KW, Ramaiya NH, Shinagare AB. Molecular targeted therapy in gynaecologic malignancies: primer for radiologists. Br J Radiol 2016; 89:20160086. [PMID: 27331884 DOI: 10.1259/bjr.20160086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The identification of characteristic genetic alteration in gynaecological malignancies has opened the door for molecular targeted therapy. The purpose of this review is to provide a primer for the radiologist on these agents with emphasis on the role of imaging in treatment response assessment and drug toxicities. The use of targeted therapy in gynaecological malignancies will likely increase in the future and make the role of the radiologist critical in response assessment and detection of toxicities.
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Affiliation(s)
- Chong Hyun Suh
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,2 Department of Radiology, Namwon Medical Center, Namwon-Si, Jeollabuk-Do, Republic of Korea
| | - Sree H Tirumani
- 3 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,4 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abhishek Keraliya
- 3 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,4 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kyung Won Kim
- 1 Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Nikhil H Ramaiya
- 3 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,4 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Atul B Shinagare
- 3 Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA.,4 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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42
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Clemente N, Alessandrini L, Rupolo M, Bulian P, Lucia E, Canzonieri V, Sopracordevole F. Primary Non-Hodgkin's Lymphoma of the Vulva: A Case Report and Literature Review. Medicine (Baltimore) 2016; 95:e3041. [PMID: 26962826 PMCID: PMC4998907 DOI: 10.1097/md.0000000000003041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to add a new case of primary non-Hodgkin's malignant lymphoma of the vulva to the literature and to review the current literature.We searched the PubMed/MEDLINE databases for previous case reports using the key words "non-Hodgkin's malignant lymphoma of the vulva," "vulvar lymphoma," and "primary vulvar non-Hodgkin's lymphoma." We found 29 cases of primary vulvar non-Hodgkin's malignant lymphoma of the vulva reported until 2015. Among them, only 8 cases of diffuse large B-cell lymphoma (DLBCL), classified according to the most recent 2008 WHO classification, were reported.Moreover, only few studies reported the therapeutic management and clinical follow-up of patients affected by this condition.Due to its uncommon presentation, the primary non-Hodgkin's malignant lymphoma of the vulva can be undiagnosed; thus gynecologists, oncologists, and pathologists should be aware of this condition, as a correct diagnosis is essential for an appropriate therapeutic management.
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Affiliation(s)
- Nicolò Clemente
- From the Gynecological Oncology Unit (NC, EL, FS); Division of Pathology (LA, VC); Cellular Therapy and High-Dose Chemotherapy Unit (MR); and Clinical and Experimental Onco-Hematology Unit (PB); CRO Centro di Riferimento Oncologico-National Cancer Institute, Aviano, Italy
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43
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Silva V, Correia P, Oliveira N, Sá L. Primary Vaginal Non-Hodgkin's Lymphoma: Report of a Rare Clinical Entity. Clin Pract 2015; 5:821. [PMID: 26918105 PMCID: PMC4745599 DOI: 10.4081/cp.2015.821] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/18/2015] [Indexed: 11/27/2022] Open
Abstract
A 52-year-old woman was referred to the gynecology outpatient clinic with a 2 months history of vaginal bleeding with intercourse, and no other symptoms. Vaginal examination revealed a firm, non-tender, mass in the posterior vaginal wall. The initial clinical impression was that of a vaginal carcinoma and a biopsy under local anesthesia was performed, but the result was inconclusive. A deeper biopsy, under general anesthesia, was performed and a histological diagnosis of non-Hodgkin’s lymphoma was done. The staging workup permitted to exclude any other site of the body affected by the malignancy. Hematologists reviewed the patient and recommended chemotherapy. A complete tumor regression was observed and the patient has now a disease-free survival of 72 months. This case report intends to create awareness of this rare clinical entity. Although the gynecologist will rarely be faced to extranodal lymphoma, it should be included in the differential diagnosis of gynecologic malignancies.
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Affiliation(s)
| | - Paulo Correia
- Portuguese Institute of Oncology Francisco Gentil , Coimbra
| | | | - Luís Sá
- Portuguese Institute of Oncology Francisco Gentil , Coimbra
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44
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An Expanded Spectrum of High-Grade B-Cell Non-Hodgkin Lymphomas Involving the Cervicovaginal Region. Int J Gynecol Pathol 2015; 34:564-9. [DOI: 10.1097/pgp.0000000000000220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Primary T-Cell Non-Hodgkin Lymphoma of the Vagina. Case Rep Obstet Gynecol 2015; 2015:893083. [PMID: 26101677 PMCID: PMC4460195 DOI: 10.1155/2015/893083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 05/19/2015] [Indexed: 11/18/2022] Open
Abstract
The primary vaginal T-cell non-Hodgkin lymphoma is a rare form of lymphoma. Most of the previously published cases were about B-cell non-Hodgkin lymphomas. We present the case of a vaginal mass in an 82-year-old patient presenting vaginal bleeding. The results of the immunohistological studies of the mass revealed the presence of a cytotoxic T-cell non-Hodgkin lymphoma, which is the least common subtype.
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Pósfai É, Nagy K, Marton I, Bánfalvi A, Kocsis L, Cserni G. Incidentally discovered diffuse large B-cell lymphoma limited to the endocervical mucosa in a young female patient. Gynecol Obstet Invest 2015; 80:134-8. [PMID: 25870905 DOI: 10.1159/000369388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 10/28/2014] [Indexed: 11/19/2022]
Abstract
Primary high-grade non-Hodgkin lymphoma of the female genital tract is extremely rare. Vaginal bleeding, abdominal pain or urinary complaints might be its most frequent symptoms. We report a 27-year-old multipara who underwent large loop excision of the transformation zone because of the repeated finding of a low-grade squamous intraepithelial lesion identified during routine cancer screening. Incidentally, CD20-positive, primary, diffuse large B-cell lymphoma infiltrating the mucosa of the endocervix was also diagnosed from this specimen. The case is unusual because the patient had no symptoms, specific colposcopic signs or visible mass. R-CHOP 21 immunochemotherapy was introduced and resulted in complete remission without hysterectomy. The patient is without any evidence of disease after 49 months of follow-up. Primary cervical lymphomas are mainly subepithelial initially, and therefore they may be under-recognized due to the inefficiency of smears to diagnose such lesions. Early diagnosis and available targeted treatment allowed a cure in the reported example.
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Affiliation(s)
- Éva Pósfai
- 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
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Li WS, Wang RC, Wang J, Chang KC. Primary nodular lymphocyte-predominant Hodgkin lymphoma of uterine cervix mimicking leiomyoma. Clin Case Rep 2015; 3:349-52. [PMID: 26185626 PMCID: PMC4498840 DOI: 10.1002/ccr3.246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 12/18/2014] [Accepted: 02/20/2015] [Indexed: 11/06/2022] Open
Abstract
Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) accounts for about 5% of all Hodgkin lymphomas and predominantly involves peripheral lymph nodes. Primary NLPHL of uterine cervix is very rare. Here, we report cervical NLPHL with CD21 expression in a 43-year-old woman, who presented with abnormal vaginal bleeding for 1 year.
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Affiliation(s)
- Wan-Shan Li
- Department of pathology and laboratory medicine, Taichung Veterans General Hospital Taichung, Taiwan
| | - Ren-Ching Wang
- Department of pathology and laboratory medicine, Taichung Veterans General Hospital Taichung, Taiwan
| | - John Wang
- Department of pathology and laboratory medicine, Taichung Veterans General Hospital Taichung, Taiwan
| | - Kung-Chao Chang
- Department of Pathology, College of Medicine, National Cheng Kung University and Hospital Tainan, Taiwan
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An Unusual Case of Diffuse Large B-Cell Lymphoma Involving the Vulva Evaluated by 18F-FDG PET/CT. Clin Nucl Med 2014; 39:e439-41. [DOI: 10.1097/rlu.0000000000000258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ahmad A, Hui P, Litkouhi B, Azodi M, Rutherford T, McCarthy S, Xu ML, Schwartz PE, Ratner E. Institutional review of primary non-hodgkin lymphoma of the female genital tract: a 33-year experience. Int J Gynecol Cancer 2014; 24:1250-5. [PMID: 25010039 PMCID: PMC8139417 DOI: 10.1097/igc.0000000000000201] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of this is to provide an updated review of the literature and to report our institutional experience with this rare gynecologic malignancy. METHODS The medical records of patients with diagnosis of non-Hodgkin lymphoma of the female genital tract from 1980 to 2013 at the Yale-New Haven Hospital were reviewed retrospectively. Histological classification and staging were determined by the World Health Organization and Ann Arbor systems, respectively. Kaplan-Meier was used to calculate the survival. RESULTS There were 36 patients with diagnosis of non-Hodgkin lymphoma of the female genital tract and followed for a median of 61 months (0-361 months). The median age of diagnosis was 44 years (19-87 years), and 76% (n = 28) were classified as stage IV.Of these, 4 patients were asymptomatic on presentation, and 13 were identified incidentally during surgery/radiography (n = 9), on prenatal ultrasound (n = 1), and on Papanicolaou test (n = 3). The location of the disease included the ovary (n = 6), uterine corpus and cervix (n= 9), vagina (n = 1), a pelvic mass (n = 7), isolated pelvic/para-aortic lymph nodes (n = 3), and/or multiple sites (n = 9). There were 6 cases that were concomitant with other gynecologic malignancies.Diffuse large B-cell lymphoma (n= 18) was the most common histologic type. A total of 28 patients underwent surgery. Combination chemotherapy was used in 34 patients, with concomitant radiation therapy in 7 and stem cell transplantation in 3. A total of 5 patients had recurrent disease.The overall median survival from the diagnosis of lymphoma was 70 months (0.3-361 months) with a 91% 1-year survival, 86% 5-year survival, and a 79% 10-year survival. CONCLUSIONS Our report is the largest published single-institution experience of this disease. It demonstrates a more favorable prognosis and proposes that with early diagnosis and appropriate therapy, radical gynecologic surgery can be avoided.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bleomycin/therapeutic use
- Combined Modality Therapy
- Cyclophosphamide/therapeutic use
- Cytarabine/therapeutic use
- Diagnosis, Differential
- Doxorubicin/therapeutic use
- Female
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/epidemiology
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/therapy
- Gynecologic Surgical Procedures/statistics & numerical data
- Humans
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/epidemiology
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Middle Aged
- Prednisolone/therapeutic use
- Prednisone/therapeutic use
- Pregnancy
- Pregnancy Complications, Neoplastic/diagnosis
- Pregnancy Complications, Neoplastic/epidemiology
- Pregnancy Complications, Neoplastic/pathology
- Pregnancy Complications, Neoplastic/therapy
- Retrospective Studies
- Survival Analysis
- Teniposide/therapeutic use
- Vincristine/therapeutic use
- Young Adult
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Affiliation(s)
- Asima Ahmad
- Yale-New Haven Hospital, 20 York St, New Haven, CT 06510, United States of America
| | - Pei Hui
- Yale University School of Medicine, 800 Howard Avenue, 3 floor, New Haven, CT 06519, United States of America
| | - Babak Litkouhi
- John Theurer Cancer Center, 92 2nd street, 4th floor (410), Hackensack University Medical Center, Hackensack NJ 07601
| | - Masoud Azodi
- Yale University School of Medicine, 800 Howard Avenue, 3 floor, New Haven, CT 06519, United States of America
| | - Thomas Rutherford
- Yale University School of Medicine, 800 Howard Avenue, 3 floor, New Haven, CT 06519, United States of America
| | - Shirley McCarthy
- Yale University School of Medicine, 800 Howard Avenue, 3 floor, New Haven, CT 06519, United States of America
| | - Mina L. Xu
- Yale University School of Medicine, 800 Howard Avenue, 3 floor, New Haven, CT 06519, United States of America
| | - Peter E. Schwartz
- Yale University School of Medicine, 800 Howard Avenue, 3 floor, New Haven, CT 06519, United States of America
| | - Elena Ratner
- Yale University School of Medicine, 800 Howard Avenue, 3 floor, New Haven, CT 06519, United States of America
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