Primary diffuse large B cell lymphoma of the breast eight years after the diagnosis of gastric MALT lymphoma: report of first case

Primary breast lymphoma (PBL) is an uncommon type of extranodal non-Hodgkin’s lymphoma (NHL), accounting for approximately 1% of all extranodal NHL. Diffuse large B cell lymphoma (DLBCL) is the most frequent histology. Both primary mucosa-associated lymphoid tissue (MALT) lymphoma of the breast and its relapse have been documented previously. We report on a 63-year-old woman with primary DLBCL of the breast which was diagnosed 8 years after gastric MALT lymphoma. Following chemotherapy, complete response was obtained. We suggest that for women presenting with a breast mass who received cytotoxic treatment for the other lymphoma, PBL should be considered in the differential diagnosis of the breast mass together with primary breast carcinoma.     

Primary breast lymphoma during pregnancy: a case report

Primary breast lymphoma is a difficult diagnosis because it is very rare. It can be found during pregnancy. Its diagnosis is often delayed. Treatment combines radiotherapy and chemotherapy. Prognosis is generally bad. Therefore, it is most important to examine breasts during pregnancy.     

Primary diffuse large B-cell lymphoma of the uterus presenting solely as an endometrial polyp.

We report a primary diffuse large B-cell lymphoma of endometrial polyp in a 44-year-old woman who presented with irregular vaginal spotting and was found to have a polyp protruding from the cervical os. Histology of the polyp showed an atypical diffuse infiltration by large, mononuclear cells within the stroma and between endometrial glands in one of the polypoid fragments. Immunohistochemistry and testing for immunoglobulin heavy chain gene rearrangement showed a B-cell lineage, consistent with diffuse large B-cell lymphoma. Staging procedures including detailed gynecology examination, body computed tomography scan, and bone marrow examination, as well as total hysterectomy, showed no evidence of lymphoma outside of the polyp. To our knowledge, this represents the first well-documented instance of primary lymphoma of the uterus presenting as an endometrial polyp. The differential diagnosis of endometrial biopsies containing an atypical lymphoid infiltrate should include the rather rare possibility of primary uterine lymphoma arising in an endometrial polyp. Immunohistochemistry and/or molecular analysis for antigen receptor gene rearrangements are critical in arriving at the correct diagnosis.     

Urethral large B-cell urethral lymphoma: A case report and literature review

ObjectiveWe report a case of diffuse large B-cell urethral lymphoma initial presenting with non-healing urethra ulcer.Case ReportA 68-year-old woman presented with a non-healing urethral ulcer accompanied with vulvar pruritus, which failed to medical treatment. Her medical history was unremarkable, lacking fever, weight loss or unexplained fatigue. There were no enlarged lymph nodes or palpable liver or spleen upon physical examination. Pelvic examination revealed an ulcerative lesion arising from the posterior wall of the urethral meatus. Cystourethroscopy showed no bladder involvement. Surgical excision of the urethral ulcer was done and immunohistochemical report showed a diffuse large B-cell lymphoma. Bone marrow needle biopsy and computed tomography were done and the diagnosis of primary diffuse large B-cell urethral lymphoma stage IEA was made. She underwent six cycles of cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab and was free of disease for 51 months.ConclusionThis report of urethral lymphoma was presented as a non-healing ulcer initially, which was totally different previous reports, presenting with bleeding, either vaginal or urinary, urinary frequency, dysuria, urine retention and self-perceived mass, suggesting that unhealed ulcer on the perineal area should be promptly evaluated and avoidance of unnecessary delayed therapy for possible curable disease.     

Primary lymphoma of the uterus. A case report

Primary uterine lymphoma is a rare gynecologic cancer. Usually it involves rather the cervix than the uterine corpus and most of them are B-cell lymphomas. We describe a case of a 43-year old, asymptomatic patient, arrived observed for ureter dilatation due to a pelvic mass diagnosed by urography. The history of the patient, the presurgical clinical and radiological findings did not reveal any sign of uterine lymphoma. These difficulties show that at present it is not possible to make any prevention for this kind of cancer. The diagnosis of lymphoma was done at frozen section during surgery, but the final diagnosis is reached after two weeks. The patient underwent a debulking surgery of the mass, ureter cleaning with introduction of ureteral stent and a node sampling was done.The correct staging and the surgical and/or medical management of this cancer (not yet standardized) are the most important factors to improve the survival of these patients.     

Primary aneuploid lymphoma of the uterine cervix: a case report

A primary, diffuse, centroblastic lymphoma of the uterine cervix is described. The patient is a 77-year-old V-parous woman, who presented with postmenopausal bleeding, but no systemic symptoms. Gynecologic examination revealed a 4 x 8-cm tumor extending from the uterine cervix to the anterior vaginal wall and elevating the bladder neck, but with no sign of mucosal infiltration. According to the FIGO classification, the tumor was classified as stage IIIA. Flowcytometric analysis showed a grossly aneuploid tumor, with a DNA content of 3.5c. The S-phase rate was 30.6%. The patient was treated with external pelvic irradiation to 46 Gy. Six weeks later the therapy was completed with seven courses of a cyclophosphamide-vincristine-prednisolone (COP) regimen. Complete tumor response was achieved and 3 years later there is no sign of relapse. Despite unfavorable prognostic parameters: large tumor volume, diffuse growth pattern, aneuploidy, and a high S-phase rate, a combination of radiotherapy and chemotherapy was found to be a successful treatment of this rare form of advanced primary lymphoma of the uterine cervix.     

Intravascular large B-cell lymphoma of the uterus: a diagnostic challenge.

A 63-year-old woman presented with postmenopausal bleeding. The initial curettage material was reported as "undifferentiated malignant tumor." A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed with pelvic lymph node dissection and omental biopsy, which showed an intravascular large B-cell lymphoma in the lumina of small blood vessels of the uterus, left tube, and right ovary. This is the first reported case of an intravascular lymphoma of the uterus.     

Primary non-Hodgkin lymphoma of the vagina: case report

The authors consider a rare case of non-Hodgkin primitive lymphoma of the vagina, 1st E stage for Ann Arbor classification. The treatment was primarily chemotherapy, because of the wide extension of the neoplasia and the older patient age, and it was followed by a complete clinical response, still lasting after two years. The results of treatments in the literature are at least examined and discussed.     

Primary malignant lymphoma of the cervix. A case report

BACKGROUND: Primary malignant lymphoma of the female genital tract is rare. A review of the literature suggests that 1 in 175 extranodal lymphomas in women is likely to originate in the vagina, uterus or cervix. Often the diagnosis of primary lymphoma is not established until after an operation has been performed. Postsurgical treatment is usually chemotherapy alone or followed by radiotherapy. CASE: A 40-year-old woman presented in January 2001 with uterine bleeding. After the patient underwent total abdominal hysterectomy, primary cervical malignant lymphoma was diagnosed. Six courses of chemotherapy were administered in an adjuvant setting. Twenty-seven months (April 2003) after the diagnosis the patient was alive and without signs of recurrent disease. CONCLUSION: Awareness of this rare clinical entity is important because these tumors can present at any age and may mimic squamous cell carcinoma of the cervix clinically and histologically. Abnormal uterine bleeding is the most common presenting symptom of primary malignant lymphoma of the cervix. Extent of disease, size of primary lesion and type of lymphoma are significant prognostic features. Radical surgery is unnecessary. Standard postsurgical treatment has not yet been established.     

Primary non-Hodgkin's lymphoma of the vulva: A case report

MacLeod C, Palmer A, Findlay M. Primary non-Hodgkin's lymphoma of the vulva: A case report. Int J Gynecol Cancer 1998; 8 : 504–508.
A 51 year-old female presented with a recurrent vulvar mass. Excision biopsy showed an incompletely excised malignant lymphoma. The Working Formulation classification was diffuse mixed large and small cell non-Hodgkin's lymphoma. Under the recently proposed classification system known as the Revised European-American Lymphoma (REAL) classification it was a diffuse large B-cell lymphoma. Primary vulvar lymphomas are rare and it was important to exclude systemic disease and an underlying immunodeficiency disorder. Possible pathogenesis, natural history and pathology are discussed. Chemotherapy and radiotherapy are the principal modalities of therapy at most sites and surgery should be limited to diagnostic purposes.     

Primary, localized vulvar B-cell lymphoma expressing CD44 variant 6 but not cadherins. A case report

BACKGROUND: Primary extranodal lymphoma of the vulva is rare, with only 17 prior cases reported. Its immunohistochemical profile has not been characterized beyond B- or T-cell phenotype. CASE: A 64-year-old, white woman presented with a nontender enlargement of the right labium minus and labium majus. Bilateral vulvar punch biopsies revealed an infiltrate of neoplastic lymphocytes that filled the reticular dermis and extended down to the subcutaneous fat. Lymphoma cells were positive for CD20 and expressed CD43 in an aberrant manner. The tumor was examined for adhesion protein expression. There was expression of CD44 standard and variant 6 but not of E-, N- or P-cadherin. No systemic spread of this rare lymphoma was evident after one year. CONCLUSION: Adhesion protein expression in primary vulvar lymphoma may have prognostic implications.     

Primary malignant lymphoma of the cervix in pregnancy. A case report.

BACKGROUND: Malignant lymphoma arising from the uterine cervix is a very rare entity. Only two such patients have been reported as pregnant at the time of diagnosis. CASE: A 35-year-old woman (negative Pap smear at antenatal clinics) was referred because of the accidental finding of a huge cervical mass during labor. The patient underwent cesarean section because of arrest of cervical dilatation and persistent floating of the fetal head. The final diagnosis of this cervical mass was malignant lymphoma, low grade B cell, after radical abdominal hysterectomy. CONCLUSION: Although labor obstructed by a tumor of the pelvic organs is a relatively rare event and the majority of cases are benign leiomyomas of the uterus or cervix, the risk of pelvic malignancies should be considered. Bimanual examination and pelvic ultrasound and/or color Doppler ultrasound should be applied without hesitancy in any uncertain situation during pregnancy or labor.     

Primary breast carcinoma of the vulva: a case report and literature review

BACKGROUND: In 1872, Hartung was the first to describe the case of a fully formed mammary gland arising in the left labium majora of a 30-year-old woman. Since Hartung's initial report, 38 additional cases of ectopic vulvar breast tissue have been described. This case report describes the rare occurrence of primary mammary adenocarcinoma arising within the vulva. CASE: A 64-year-old G4P4 white female presented with a 4-year history of a 2 x 1 cm firm, indurated, raised lesion of the left lateral mons. A wide local excision with ipsilateral inguinofemoral lymphadenectomy was performed. Given histological findings characteristic of both invasive ductal carcinoma and invasive lobular carcinoma, in conjunction with the presence of estrogen and progesterone receptors within the tumor, a diagnosis of infiltrating adenocarcinoma arising within ectopic breast tissue was made. CONCLUSIONS: Thirty-nine reported cases of ectopic breast tissue arising within the vulva have been reported in the world literature. Though the diagnosis of primary breast carcinoma arising within the vulva is based primarily upon histologic pattern, estrogen and progesterone receptor positivity provide supporting evidence. Given the rarity of this condition, guidelines for therapy are unavailable; we therefore suggest looking to the current management of breast cancer in order to establish a sensible approach.     

Non-Hodgkin's B-cell lymphoma of the ovary: A case report and review of the literature

ObjectiveTo report a case and review published cases of non-Hodgkin's lymphoma of the ovary.Case reportA 30-year-old female presented with abdominal fullness. Abdominal CT revealed bilateral huge ovarian masses with moderate amount of ascites. Explore laparotomy was performed and the frozen section of right ovarian mass reported to be malignant lymphoma. The final diagnosis was Ann Arbor stage IV diffuse large B cell lymphoma. The patient received six cycles of chemotherapy with RCHOP regimen. She achieved complete remission after the treatment, and there's no evidence of recurrence after 12 months follow up.ConclusionOvarian lymphoma is a rare condition. It could present with findings mimicking ovarian cancer. Chemotherapy is the main treatment option and cytoreductive surgery should be avoided.