Primary diffuse large B-cell lymphoma of the fallopian tube treated with a combination of surgery and chemotherapy

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.

Primary ovarian lymphoma misdiagnosed as epithelial carcinoma: a case report and literature review

“…(1) Dysgerminoma: Because of the proliferation of single cells, ovarian DLBCL is di cult to distinguish from dysgerminoma, but immunohistochemistry can be utilized to identify it. The B-cell markers CD20 and CD79a are present in DLBCL but are not expressed in dysgerminoma [15,16]. (2) Epithelial ovarian cancer: The tumor was cystic and solid, with mural nodules.…”

Successful pregnancy via in vitro fertilization in a primary infertile woman with primary lymphoma of the fallopian tube after surgery: A case report and literature review

“…The most common sites of PLFGT are the ovary and cervix, and involvement of the fallopian tubes is extremely rare with only 6 cases reported (Table 1). [1–6]…”

“…[1][2][3][4][5][6] Clinical diagnosis of primary lymphoma of the fallopian tube is difficult. Based on prior reports and our case, [2][3][4][5][6][7] its clinical manifestations are unremarkable and unspecific, such as dysmenorrhea and pelvic pain, other than the typical signs of lymphoma such as swelling of surface lymph nodes, fever, night sweats, and weight loss. Localized symptoms such as dysmenorrhea and pelvic pain may also be associated with pelvic inflammatory disease, endometriosis, and adenomyosis.…”

“…The most common sites of PLFGT are the ovary and cervix, and involvement of the fallopian tubes is extremely rare with only 6 cases reported (Table 1). [1][2][3][4][5][6] Clinical diagnosis of primary lymphoma of the fallopian tube is difficult. Based on prior reports and our case, [2][3][4][5][6][7] its clinical manifestations are unremarkable and unspecific, such as dysmenorrhea and pelvic pain, other than the typical signs of lymphoma such as swelling of surface lymph nodes, fever, night sweats, and weight loss.…”

“…[1] The primary lymphomas of the female genital tract are extremely rare, especially in the fallopian tube. To the best of our knowledge, only 6 cases of primary fallopian tube lymphomas were ever reported, [2–7] and all of those women did not have fertility requirements. Thus, this is the first reported case of an infertile woman with MZBL of MALT-type involving the fallopian tube.…”