Japanese Journal of Clinical Oncology 30:519-521 (2000)
© 2000 Foundation for Promotion of Cancer Research
Magnetic Resonance Images of Primary Malignant Lymphoma of the Uterine Body: A Case Report
1Department of Radiology, Gunma Cancer Center, Ota, Gunma and 2Department of Radiology and Radiation Oncology, Gunma University School of Medicine, Maebashi, Gunma, Japan
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONCASE REPORTDISCUSSIONAcknowledgmentsREFERENCES |
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Primary malignant lymphoma of the uterine body is extremely rare. There are few reports concerning magnetic resonance images (MR) of uterine body lymphoma although there are several reports concerning uterine cervical lymphoma. The MR images of a 66-year-old woman with primary malignant lymphoma of the uterine body showed that the myometrium was diffusely involved, exhibiting an almost homogeneous character, and the normal zonal anatomy of the uterine cervix was preserved, with the endometrium being partly recognized near the center of the tumor. We report suggestive findings on MR images of primary malignant lymphoma of the uterine body.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONCASE REPORTDISCUSSIONAcknowledgmentsREFERENCES |
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Primary malignant lymphoma of the uterus is a rare disease. Among uterine lymphomas, the cervix is a more prevalent site than the uterine body (1,2), and primary malignant lymphoma of the uterine body (PMLUB) is extremely rare. Although there are several reports concerning magnetic resonance (MR) images of uterine lymphomas (3–6), in most of them both the cervix and uterine body were involved.
In this paper, we report a case of PMLUB with preserved normal anatomy of the cervix on MR images.
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CASE REPORT |
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TOPABSTRACTINTRODUCTIONCASE REPORTDISCUSSIONAcknowledgmentsREFERENCES |
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A 66-year-old woman suffering from lumbago and appetite loss was admitted to the Department of Gynecology in our hospital on December 1995. She had not been experiencing genital bleeding. Physical and ultrasound examinations revealed a large pelvic mass. However, we could not clarify the origin. On pelvic examination, the uterine cervix was normal in appearance. Biopsies from the cervix and the endometrium were negative for malignancy. Under these circumstances, our gynecologist clinically diagnosed this as ovarian tumor. The value of serum lactate dehydrogenase was markedly increased to 1952 IU/ml (normal: 180–460 IU/ml).
MR was performed with a 1.5 T unit (Signa Advantage, GE) using a pelvic phased array coil. MR images showed marked enlargement of the uterine body to a size of 13 x 9 x 8 cm. On fast spin-echo T2-weighted image (TR/TE: 3300/78.2), the myometrium was diffusely involved, showing almost homogeneous and relatively high signal intensity (Fig. 1a). The normal zonal anatomy of the uterine cervix was preserved and the endometrium was partly recognized near the center of the tumor (Fig. 1a and b). MR images obtained with rapid administration of gadolinium–DTPA did not exhibit any early distinctive contrast enhancement effect of the tumor. A contrast-enhanced spin-echo T1-weighted image (TR/TE: 500/16) showed relatively homogeneous and moderate enhancement of the tumor (Fig. 1c). Involvement of pelvic lymph nodes was also observed. We thought that these findings were not suitable for endometrial carcinoma. Although we could not clarify what type of sarcoma was present, the diagnosis on MR imaging was sarcoma of the uterine body including malignant lymphoma.
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Computed axial tomography of the chest and abdomen showed the involvement of para-aortic lymph nodes in addition to those of the uterus and pelvis.
Her condition deteriorated rapidly and she died 2 months after admission to our hospital. Histological confirmation could not be obtained during her lifetime.
Pathological autopsy was performed and primary malignant lymphoma of the uterine body was confirmed. Macroscopic involvement was observed in the uterus and pelvic and para-aortic lymph nodes. The uterine tumor had invaded the bilateral ovaries and the posterior wall of the bladder. The liver, spleen and adrenal glands were also involved microscopically. The histological diagnosis was non-Hodgkin lymphoma diffuse large B-cell type.
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DISCUSSION |
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TOPABSTRACTINTRODUCTIONCASE REPORTDISCUSSIONAcknowledgmentsREFERENCES |
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Various types of gross tumor appearance in PMLUB have been reported (1,2,7). The involvement ranged from small superficial lesions of the endometrium to that of the entire uterine body. The most common type was enlargement of the myometrium. Another common type was diffuse thickening of the endometrium without myometrial involvement. As rare cases, polypoid lesions that protruded through the cervical canal with or without diffuse coating of the endometrium were reported (7).
Are there any characteristic findings of PMLUB on MR images? Kawakami et al. (5) reported a patient who had diffuse involvement of the cervix and corpus without obvious disruption of the endometrium and cervical epithelium. They concluded that this finding is one of the appearances of lymphoma, which we speculate is a specific finding for diagnosing this disease. Kim et al. (6) reported that a relatively homogeneous signal intensity on an MR image in spite of a large tumor size is helpful for diagnosing uterine lymphoma. Yamada and Suzuki (3) reported a patient with involvement in both the endometrium and myometrium without any disruption of the junctional zone as a rare case. They suggested that the intact junctional zone was a specific feature of lymphoma because lymphoma cells might infiltrate the entire layer of the uterus without destroying the normal uterine architecture.
The MR images in our case were consistent with those of the published reports in terms of a large uterine tumor with relatively homogeneous signal intensity on the T2-weighted image and partly intact endometrium. In addition, it is considered to be one of the suggestive findings on MRI of PMLUB that the cervix retains an intact normal zonal anatomy despite the extensive involvement of the uterine body.
A standard treatment has not been established for primary uterine lymphoma because of its rarity. However, chemotherapy, radiotherapy and their combination have been successfully applied in the cases without disseminated disease (3). Early detection, diagnosis and treatment are essential for the cure of PMLUB.
In this regard, MR imaging can play an important role in the diagnosis of this rare disease.
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Acknowledgments |
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TOPABSTRACTINTRODUCTIONCASE REPORTDISCUSSIONAcknowledgmentsREFERENCES |
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This work was supported in part by a Grant-in-Aid for Cancer Research (10–25) from the Ministry of Health and Welfare of Japan.
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FOOTNOTES |
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+ For reprints and all correpondence: Yoshiyuki Suzuki, Department of Radiology and Radiation Oncology, Gunma University School of Medicine, 3–39–22 Showa-machi, Maebashi, Gunma 371-8511, Japan
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REFERENCES |
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1 Harris NL, Scully RE. Malignant lymphoma and granulocytic sarcoma of the uterus and vagina. Cancer 1984;53:2530–45.[Web of Science][Medline]
2 Stroh EL, Besa PC, Cox JD, Fuller LM, Cabanillas FF. Treatment of patients with lymphomas of uterus or cervix with combination chemotherapy and radiation therapy. Cancer 1995;75:2392–9.[Web of Science][Medline]
3 Yamada I, Suzuki S. Primary uterine lymphoma. Am J Roentgenol 1993;160:662–3.[Web of Science][Medline]
4 Lien HH, Nome A. Lymphoma of the uterus. Am J Roentgenol 1994;163:996.[Web of Science][Medline]
5 Kawakami S, Togashi K, Kojima N, Morikawa K, Mori T, Konishi J. MR appearance of malignant lymphoma of the uterus. J Comput Assist Tomogr 1995;19:238–42.[Web of Science][Medline]
6 Kim YS, Koh BH, Cho OK, Rhim CH. MR imaging of primary uterine lymphoma. Abdom Imaging 1997;22:441–4.[Web of Science][Medline]
7 Rijn M, Kamel OW, Chang PP, Lee A, Warnke RA, Salhany KE. Primary low-grade endometrial B-cell lymphomas. Am J Surg Pathol 1997;21:187–94.[Web of Science][Medline]
Received May 8, 2000; accepted August 28, 2000.
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  M S Thyagarajan, M J Dobson, and A Biswas Appearance of uterine cervical lymphoma on MRI: a case report and review of the literature Br. J. Radiol., June 1, 2004; 77(918): 512 - 515. [Abstract] [Full Text] [PDF]
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