Leukemia / lymphoma

Uterus
Other tumors
Leukemia / lymphoma

Author: Vijay Shankar, M.D. (see Authors page)

Revised: 19 September 2016, last major update September 2016

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Uterus [title] Leukemia lymphoma

Table of Contents

Cite this page: Leukemia / lymphoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusleukemialymphoma.html. Accessed July 16th, 2017.

Definition / general

Primary malignant lymphoma of the uterus is extremely rare
Most are Non Hodgkin lymphoma
- Diffuse large B cell lymphoma is the most common subtype
- NK / T cell lymphoma, plasmablastic lymphoma, peripheral T cell lymphoma and Burkitt lymphoma have also been reported
- Low grade endometrial lymphoma is rare (Am J Surg Pathol 1997;21:187)
Hodgkin lymphoma is extremely rare
- Only seven HL cases of uterine cervix have been reported since 1960 (Clin Case Rep 2015;3:349)
Metastasis of lymphoma to uterus has been reported
Uterus can also be involved in leukemia
- Rarely granulocytic sarcomas can arise in uterus (Case Reports in Radiology 2014: 2014, Article ID 501342)
- More commonly (7%) involved by CLL
Large cell lymphoma and granulocytic sarcoma resemble endometrial stromal sarcoma

Essential features

Primary malignant lymphoma of the female genital tract is extremely rare
Non Hodgkin lymphoma is the most common type
Vaginal bleeding is the most common presenting symptom
Immunohistochemical examination is necessary to determine the type and subtype of lymphoma

Epidemiology

Accounts for 0.5% of extranodal lymphoma
Can occur in elderly women, although no age is exempt

Sites

Uterine corpus and cervix
Rarely arises within leiomyoma (Diagn Pathol 2016;11:9)

Clinical features

Vaginal bleeding is the most common presenting symptom, followed by abdominal pain or urinary obstruction
Rarely presents with nonspecific symptoms such as intermittent fever (Medicine (Baltimore) 2016;95:e3532), abdominal bloating, pressure, discomfort

Diagnosis

Criteria for diagnosis of primary lymphoma by Fox and More (J Clin Pathol 1965;18:723)
- Clinically confined to the uterus
- No evidence of leukemia
- A fairly long interval between any prior lymphoma and the current uterine tumor

Radiology images

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Primary lymphoma of the uterine cervix

Prognostic factors

Depends on tumor stage, location and subtype
Low stage tumors: usually involve cervix, 5 year survival 83%
High stage tumors: usually involve uterine corpus, 5 year survival 29%

Case reports

27 year old women with intermittent fever and neutropenia for 7 months (Medicine (Baltimore) 2016;95:e3532)
41 year old woman with fever and abdominal pain for 2 months (Diagn Pathol 2014;9:95)
42 year old woman with menorrhagia of 2 months duration (CCIJ-Lymphoblastic leukemia)
43 year old woman with Hodgkin lymphoma of uterus (Clin Case Rep 2015;3:349)
54 year old woman with difficulty in micturition (Taiwan J Obstet Gynecol 2015;54:71)
63 year old woman with lymphoma of uterus and broad ligament (Onco Targets Ther 2015;8:265)
65 year old woman with postmenopausal bleeding, back pain, night sweats, lethargy and a 15 kg weight loss (Gynecol Oncol Rep 2015;13:30)
69 year old woman with a 1 month history of lower abdominal discomfort, back pain and sudden hematuria (J Cytol 2015;32:181)
72 year old woman with abdominal fullness (Int J Clin Exp Pathol 2013;6:2979)
73 year old women with uterine mass for 23 years (Diagn Pathol 2016;11:9)
79 year old woman with urinary obstruction (Case Rep Oncol 2011;4:560)
85 year old woman with primary lymphoma of cervix (BMJ Case Rep 2012;2012:bcr2012006675)

Treatment

Combined surgical resection, radiation therapy and chemotherapy

Gross description

Poorly circumscribed mass of variable size, with or without necrosis
May be diffuse involvement or infiltration of adjacent structures

Gross images

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Poorly circumscribed mass

Microscopic (histologic) description

Microscopic findings vary by lymphoma subtype
Diffuse large B cell lympoma
- May be vaguely nodular
- Sheets of large neoplastic cells infiltrate deeply in stroma, frequently with interspersed residual collagen bundles
- Preserved bundles of smooth muscle may be pushed apart by sheets of lymphoma
- Cells are moderate to large round cells with pleomorphic vesicular nuclei and prominent nucleoli
- Frequent mitotic figures

Microscopic (histologic) images

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