An Unusual Coexistence of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma with Endometrioid-Type Endometrial Cancer in a 58-Year-Old Woman: A Case Study with Literature Review

A rare cause of postmenopausal bleeding: chronic lymphocytic leukemia

OBJECTIVE

Postmenopausal bleeding has been reported in about 4-11% of menopausal women. The most common cause of postmenopausal bleeding is atrophy of the vaginal mucosa or endometrium. Endometrial hyperplasia, endometrial polyps, submucous leiomyomas and endometrial cancers are also known causes of postmenopausal bleeding. Here, we present a patient whose cause of postmenopausal vaginal bleeding was infiltration of the endometrium with chronic lymphocytic leukemia (CLL).

CASE REPORT

A 78-year-old woman, who has been followed up with a diagnosis of CLL for 5 years, presented with a complaint of postmenopausal bleeding. After dilation and curettage, pathology revealed that the cause of the postmenopausal bleeding was CLL infiltration into the endometrium.

CONCLUSION

Any involvement of the female genital organs in CLL is rare. Therefore, hematological malignancies should be considered in the differential diagnosis of postmenopausal bleeding.

A successful intraoperative diagnosis of coexisting lymphoma and endometrial cancer

BACKGROUND

The coexistence of hematological malignancy with endometrial cancer is a rare phenomenon. We report a case of coexistence of endometrial cancer with follicular lymphoma which we suspected preoperatively and diagnosed during surgery by a multidisciplinary intraoperative assessment.

CASE PRESENTATION

A 67-year-old woman was referred to our hospital due to a suspicion of an endometrial cancer. Endometrial biopsy revealed grade 1 endometrioid adenocarcinoma. MRI showed invasion of the tumor into the outer half of the myometrium, and abdominal CT showed para-aortic and atypical mesentery lymphadenopathy which was suspected to be metastasis of endometrial cancer or malignant lymphoma. Abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, partial omentectomy, and mesentery lymph node biopsy for endometrial cancer were performed. The mesentery and para-aortic lymph nodes that were sent for frozen section analysis showed no metastasis of the endometrial cancer. We simultaneously conducted an unusual intraoperative emergent four-color flow cytometry and intraoperatively diagnosed a B cell lymphoma in the mesenteric lymph nodes. Because this multidisciplinary assessment, we were able to avoid an unnecessary intestinal resection. The final pathological diagnosis was an endometrioid carcinoma (G1, FIGO stage IA), with a synchronous follicular lymphoma.

CONCLUSION

Although a rare event in endometrial cancer surgery, it is necessary to be alert to the possibility of a synchronous lymphoma in cases of unusual site adenopathy.