1
|
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.
Collapse
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
| |
Collapse
|
2
|
Shi S, Li W, Ni G, Ding J, Liu Y, Wu H, Zhang Z, Ding Z. Primary lymphoma of the female genital tract masquerading as gynecological malignancy. BMC Womens Health 2024; 24:247. [PMID: 38637800 PMCID: PMC11025207 DOI: 10.1186/s12905-024-03037-8] [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] [Received: 10/30/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Primary lymphoma of the female genital tract (PLFGT) is a rare malignant tumor in the female reproductive system, with a low incidence and few clinical reports. The aim of this study is to report our institutional experience with this rare malignancy and emphasize the need for increasing the awareness about PLFGT presenting with gynecologic symptoms. METHODS The medical records of patients diagnosed with PLFGT from March 2014 to November 2022 in the First Affiliated Hospital of Wannan Medical College were reviewed. Histological classification and staging were based on the World Health Organization and Ann Arbor systems, respectively. RESULTS There were 13 patients with diagnosis of PLFGT and the median length of follow-up was 31 months (0-102 months). The main clinical symptoms included postmenopausal vaginal bleeding, pelvic mass and abdominal pain. Serum LDH increased in 10 patients and serum CA125 elevated in 2 patients. The tumor of ovarian or uterine presented as solid masses in CT or MRI, and ascites was rare. The histological subtypes were diffuse large B-cell (n = 12) and follicular (n = 1) lymphoma. Tumors were located in ovary (n = 8), uterus (n = 3), and cervix (n = 2). According to the Ann Arbor staging system, 6 cases were classified as stage II and 7 cases were classified as stage IV, respectively. A total of 10 patients underwent surgery. Combination chemotherapy was used in 10 patients. Eight patients had tumor-free survival, 1 patient had recurrent disease, 3 patients died and 1 patient lost to follow-up. The median survival time was 32 months (1-102 months). CONCLUSION PLFGT usually presents as gynecological symptoms and solid masses in pelvis. Surgery or biopsy was the way to obtain the pathologic diagnosis, and combination chemotherapy is the efficient method for PLFGT. Making an accurate preoperative diagnosis is of paramount importance to avoid radical gynecologic surgery.
Collapse
Affiliation(s)
- Suhua Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Wuan Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Guantai Ni
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Jin Ding
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Yinhua Liu
- Department of Pathology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Haixing Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Zhen Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Zhimin Ding
- Department of Radiology, The First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241000, China.
| |
Collapse
|
3
|
Kim SY, Koo JH, Lee J, Koo YJ, Gu MJ, Lee DH. Primary diffuse large B-cell lymphoma of the vulva: a case report. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:S87-S92. [PMID: 37096360 DOI: 10.12701/jyms.2023.00108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is a subtype of non-Hodgkin lymphoma (NHL) and is estimated to account for approximately 30% of all NHL cases. NHL can also occur in the female genital tract and accounts for approximately 1.5% of all NHL cases. Many doctors have difficulty diagnosing or treating vulvar DLBCL because of its very low prevalence. A 55-year-old woman presented with a solid mass on the right side of the vulva. No significantly enlarged lymph nodes were observed in the inguinal region. She underwent excisional biopsy at our institution. DLBCL was diagnosed based on histological examination. According to the Hans algorithm, the lesion was diagnosed as a non-germinal center B-cell-like subtype. The patient was referred to a hematologic oncologist. The disease stage was classified as IE according to the Ann Arbor staging classification. The patient received four cycles of chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone and localized radiation therapy with 36 Gy in 20 fractions. She showed complete remission and maintained this status on the latest computed tomography scan. Gynecologists should rule out lymphoma in patients presenting with a vulvar mass.
Collapse
Affiliation(s)
- Sun Yeon Kim
- Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ju Hwan Koo
- Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea
| | - Juhun Lee
- Department of Obstetrics and Gynecology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Yu Jin Koo
- Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea
| | - Mi Jin Gu
- Department of Pathology, Yeungnam University College of Medicine, Daegu, Korea
| | - Dae Hyung Lee
- Department of Obstetrics and Gynecology, Yeungnam University College of Medicine, Daegu, Korea
| |
Collapse
|
4
|
Furlan K, Rohra P, Mir F, Gattuso P. Non-human-papillomavirus-related malignancies of the vulva: A clinicopathological study. J Cutan Pathol 2020; 47:917-922. [PMID: 32511773 DOI: 10.1111/cup.13768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Malignant tumor of the vulva is the fourth gynecological malignancy in frequency. Close to 70% of all vulvar malignancies are related to high-risk human papillomavirus (HPV) infection. METHODS A search for non-HPV-related malignant tumors of the vulva was performed in the last 20 years (2000-2020) in the pathology database of a single tertiary institution. We aim to estimate the prevalence of non-HPV-related malignancies in our population, describe clinicopathological features of these tumors and investigate the expression of some potential therapeutic targets. RESULTS A total of 71 patients were recovered; 26 patients (36%) had the diagnosis of extramammary Paget disease, 17 patients (24%) had basal cell carcinomas, 17 patients (24%) had primary melanomas, 10 patients (14%) had metastatic disease to the vulva and one patient (1%) had a primary dermatofibrosarcoma protuberans. Fifty-four percent of patients with extramammary Paget disease had a secondary malignancy and 12.5% had invasive disease. Programmed death-ligand 1 (PDL-1) was positive in seven out of nine primary melanomas and Her2/neu was overexpressed in six out of seven extramammary Paget disease. CONCLUSION Non-HPV-related malignancies are important differential diagnoses in patient with vulvar lesions. Additional research is necessary to further understand these complex malignancies and potential new therapeutic targets.
Collapse
Affiliation(s)
- Karina Furlan
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
5
|
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.
Collapse
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.
| |
Collapse
|
6
|
Ye AL, Willis MS, Link BK, Naridze RL, Syrbu SI, Liu V. Primary diffuse large B cell lymphoma of the vulva-Two new cases of a rare entity and review of the literature. JAAD Case Rep 2018; 4:962-967. [PMID: 30364749 PMCID: PMC6197943 DOI: 10.1016/j.jdcr.2018.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Alice L Ye
- Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | | | - Brian K Link
- Department of Internal Medicine - Hematology, Oncology and Blood and Marrow Transplantation, University of Iowa, Iowa City, Iowa
| | | | - Sergei I Syrbu
- Department of Pathology, University of Iowa, Iowa City, Iowa
| | - Vincent Liu
- Department of Dermatology, University of Iowa, Iowa City, Iowa.,Department of Pathology, University of Iowa, Iowa City, Iowa
| |
Collapse
|
7
|
Abstract
Primary extranodal lymphomatous involvement of the genitourinary tract is rare and secondary extranodal involvement in disseminated disease occurs more frequently. Imaging of metabolic activity with 2-(fluorine-18) fluoro-2-deoxy-d-glucose (FDG) used in PET facilitates the identification of these extranodal sites of disease, particularly in the absence of structural lesions on conventional imaging modalities. Primary extranodal lymphoma affecting the genitourinary system is often caused by high-grade Non-Hodgkin's Lymphoma (NHL) with the most common subtype being diffuse large B-cell lymphoma (DLBCL). Although rare, the incidence of extranodal lymphoproliferative disease is increasing and a delay in diagnosis holds a poor prognosis. Familiarity with benign and physiological causes of FDG uptake, particularly due to the urinary tracer excretion is crucial in identifying sites of lymphomatous involvement in the genitourinary system. Additionally, non-lymphomatous malignancies are usually treated surgically, whereas lymphoma is primarily treated with chemotherapy and/or radiotherapy. Therefore, accurate identification and staging together with histological confirmation significantly impacts management of these patients. This article serves to review and illustrate the imaging findings on FDG-PET/CT of primary extranodal lymphoma affecting the genitourinary system.
Collapse
Affiliation(s)
- Nikita Naik
- 1 Department of Nuclear Medicine and PET, Liverpool Hospital , Liverpool, NSW , Australia
| | - Michael Lin
- 1 Department of Nuclear Medicine and PET, Liverpool Hospital , Liverpool, NSW , Australia.,2 Western Sydney University , Sydney, NSW , Australia.,3 University of New South Wales , Sydney, NSW , Australia
| | - Peter Lin
- 1 Department of Nuclear Medicine and PET, Liverpool Hospital , Liverpool, NSW , Australia.,2 Western Sydney University , Sydney, NSW , Australia.,3 University of New South Wales , Sydney, NSW , Australia
| |
Collapse
|
8
|
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.
Collapse
|
9
|
Painless Vulvar Masses as Initial Manifestation of Marginal Zone Lymphoma. J Low Genit Tract Dis 2017; 22:82-84. [PMID: 29271861 DOI: 10.1097/lgt.0000000000000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
10
|
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: 42] [Impact Index Per Article: 6.0] [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.
Collapse
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
| |
Collapse
|
11
|
Lymphoma Presenting as a Mass of the Vulva: Report of a Case of a Rare Vulvar Neoplasm Not Treated by Surgery. J Low Genit Tract Dis 2017; 21:e26-e27. [PMID: 28166106 DOI: 10.1097/lgt.0000000000000296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|