Hysteroscopic Resection Followed by Adjuvant Radiotherapy: Report of a New Therapeutic Approach to Primary Cervical Diffuse Large B-Cell Lymphoma

Abstract

The female genital tract can be involved as a secondary manifestation of disseminated lymphomas or leukemia but can rarely be the primary site of so-called extranodal lymphomas. Primary lymphomas of the female genital tract can affect the uterine corpus, uterine cervix, vulva, vagina or adnexa. Only about 0.008% of all cervical tumors are primary malignant lymphomas. The presenting symptoms are unspecific and also refer to much more common diseases of the female genital tract. Cervical cytology is usually negative. Preoperative diagnosis requires deep cervical biopsy. To date there is no consensus regarding optimal treatment. Radiotherapy, chemotherapy and surgery are used in different association. We report the first case reported in literature managed with an urgent hysteroscopic resection of a primary cervical diffuse large B-cell lymphoma, followed by adjuvant radiotherapy. Relevant literature was reviewed. Our conservative approach needs to be validated in the future, especially for women with pregnancy desire and for those with low performance status. To date, after 24 months from diagnosis, our patient is still disease-free.

A rare case of follicular lymphoma of the bladder

“… 11 , 12 A more recent case involving resection followed by adjunct local radiotherapy (45 Gy/25 fr) for a primary cervical diffuse large B-cell lymphoma provides an insight into potential standard treatments as well. 13 This treatment strategy was considered for this case, but ultimately the decision was made for surveillance without radiation therapy given the patient's desires and presence of complete resection on TURBT.…”

Management of Primary Uterine Cervix B-Cell Lymphoma Stage IE and Fertility Sparing Outcome: A Systematic Review of the Literature

“…Surgery (mainly total abdominal hysterectomy with or without salpingo/oophorectomy and lymphadenectomy) is usually performed cautiously if a precise preoperative diagnosis is not possible. In a published manuscript, we have reported a case treated with hysteroscopic resection, which to date is the only one reported in the literature [56]. Hysteroscopy appears to be a very promising tool for the treatment of organ-limited utero-cervical pathology [29,30].…”

“…Nevertheless, from the data of this review emerges a non-inferiority of the surgery + RT approach (considering ovarian transposition) compared to the CT ± RT approach. Furthermore, also in elderly women or in patients who are ineligible for chemotherapy, a conservative surgery and radiotherapic approach can be considered in order to reduce side effects and morbidity [56]. In conclusion, in the absence of a consensus on the best management, proper instrumental staging and detailed counselling with the patient is recommended to tailor the best treatment.…”