Ahmad Asima Kaleem, Hui Pei, Litkouhi Babak, Azodi Masoud, Rutherford Thomas, McCarthy Shirley, Xu Mina LuQing, Schwartz Peter E, Ratner Elena
*Yale-New Haven Hospital; †Yale University School of Medicine, New Haven, CT; and ‡John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ.
Int J Gynecol Cancer. 2014 Sep;24(7):1250-5. doi: 10.1097/IGC.0000000000000201.
The aim of this is to provide an updated review of the literature and to report our institutional experience with this rare gynecologic malignancy.
The medical records of patients with diagnosis of non-Hodgkin lymphoma of the female genital tract from 1980 to 2013 at the Yale-New Haven Hospital were reviewed retrospectively. Histological classification and staging were determined by the World Health Organization and Ann Arbor systems, respectively. Kaplan-Meier was used to calculate the survival.
There were 36 patients with diagnosis of non-Hodgkin lymphoma of the female genital tract and followed for a median of 61 months (0-361 months). The median age of diagnosis was 44 years (19-87 years), and 76% (n = 28) were classified as stage IV.Of these, 4 patients were asymptomatic on presentation, and 13 were identified incidentally during surgery/radiography (n = 9), on prenatal ultrasound (n = 1), and on Papanicolaou test (n = 3). The location of the disease included the ovary (n = 6), uterine corpus and cervix (n= 9), vagina (n = 1), a pelvic mass (n = 7), isolated pelvic/para-aortic lymph nodes (n = 3), and/or multiple sites (n = 9). There were 6 cases that were concomitant with other gynecologic malignancies.Diffuse large B-cell lymphoma (n= 18) was the most common histologic type. A total of 28 patients underwent surgery. Combination chemotherapy was used in 34 patients, with concomitant radiation therapy in 7 and stem cell transplantation in 3. A total of 5 patients had recurrent disease.The overall median survival from the diagnosis of lymphoma was 70 months (0.3-361 months) with a 91% 1-year survival, 86% 5-year survival, and a 79% 10-year survival.
Our report is the largest published single-institution experience of this disease. It demonstrates a more favorable prognosis and proposes that with early diagnosis and appropriate therapy, radical gynecologic surgery can be avoided.
本研究旨在对相关文献进行更新回顾，并报告我们机构对这种罕见妇科恶性肿瘤的治疗经验。
回顾性分析1980年至2013年在耶鲁-纽黑文医院诊断为女性生殖道非霍奇金淋巴瘤患者的病历。组织学分类和分期分别根据世界卫生组织和安阿伯系统确定。采用Kaplan-Meier法计算生存率。
共有36例女性生殖道非霍奇金淋巴瘤患者，中位随访时间为61个月（0至361个月）。诊断时的中位年龄为44岁（19至87岁），76%（n = 28）被归类为IV期。其中，4例患者初诊时无症状，13例在手术/放射检查（n = 9）、产前超声检查（n = 1）和巴氏试验（n = 3）时偶然发现。疾病部位包括卵巢（n = 6）、子宫体和宫颈（n = 9）、阴道（n = 1）、盆腔肿块（n = 7）、孤立的盆腔/腹主动脉旁淋巴结（n = 3）和/或多个部位（n = 9）。有6例患者同时合并其他妇科恶性肿瘤。弥漫性大B细胞淋巴瘤（n = 18）是最常见的组织学类型。共有28例患者接受了手术。34例患者采用了联合化疗，7例同时接受了放疗，3例接受了干细胞移植。共有5例患者出现疾病复发。淋巴瘤诊断后的总体中位生存期为70个月（0.3至361个月），1年生存率为91%，5年生存率为86%，10年生存率为79%。
我们的报告是已发表的关于该疾病最大的单机构经验。它显示出更良好的预后，并提出通过早期诊断和适当治疗，可以避免根治性妇科手术。
