Diagnostic Radiology Department, Mansoura University, Mansoura, Egypt.
Medical Oncology Department, Mansoura University, Mansoura, Egypt.
Curr Med Imaging. 2021;17(9):1159-1166. doi: 10.2174/1573405617666210120094711.
Lymphoma of the female gynecologic tract is extremely rare. Typically, lymphoma is managed nonsurgically unlike other non-lymphomatous malignant tumors raising the importance of differentiation between both entities.
We describe the Magnetic Resonance Imaging (MRI) features of a case of uterovaginal diffuse large B-cell lymphoma in a 50-year-old postmenopausal woman emphasizing Diffusion-Weighted Imaging (DWI) as a diagnostic and follow up tool. We reviewed the literature regarding the diagnostic methods for female genital lymphoma. Forty-five cases, including our patient, were reviewed with an age range from 22 to 85 years. Vaginal bleeding was the most common presentation. The diagnosis was established by Papanicolaou smear, cervical biopsy (25/45), endometrial biopsy (6/45), vaginal biopsy (2/45), pelvic mass biopsy (2/45), iliac LN biopsy (1/45) and surgical diagnosis (8/45). Diffuse Large B-Cell Lymphomas (DLBCL) constitute the vast majority of the cases (82%). The uterine cervix was involved at diagnosis in the majority of these cases (68%), while the uterine body (42%) and vagina (28%) were less involved. Pelvic lymphadenopathy was found in 15 cases, while extra genital lymphomatous infiltration in 13 cases. Sonographic findings were nonspecific, while CT provided excellent data about extra-genital involvement. Thirteen cases underwent pelvic MRI that displayed superior detection of disease extension and parametric involvement. Diffusion restriction was reported only in one case without quantitative analysis of ADC map.
MRI shows unique features that differentiate uterovaginal lymphoma from the much more common carcinomas and discriminate post-operative changes from tumor recurrence. It exhibits a marked restricted diffusion pattern with lower ADC values than carcinomas and post-operative changes.
女性生殖道淋巴瘤极为罕见。与其他非淋巴瘤恶性肿瘤不同，淋巴瘤通常采用非手术方式治疗，因此鉴别这两种疾病尤为重要。
我们描述了一位 50 岁绝经后女性阴道弥漫性大 B 细胞淋巴瘤的磁共振成像（MRI）特征，强调弥散加权成像（DWI）作为一种诊断和随访工具。我们回顾了女性生殖道淋巴瘤的诊断方法文献。共回顾了 45 例患者，年龄 22 至 85 岁。阴道出血是最常见的表现。通过巴氏涂片、宫颈活检（25/45）、子宫内膜活检（6/45）、阴道活检（2/45）、盆腔肿块活检（2/45）、髂淋巴结活检（1/45）和手术诊断（8/45）来确诊。弥漫性大 B 细胞淋巴瘤（DLBCL）构成了绝大多数病例（82%）。这些病例中大多数在诊断时累及子宫颈（68%），而子宫体（42%）和阴道（28%）受累较少。盆腔淋巴结病在 15 例中发现，而 13 例有外生殖器淋巴瘤浸润。超声检查结果无特异性，而 CT 能很好地提供外生殖器受累情况。13 例行盆腔 MRI 检查，显示出更好的疾病扩展和参数受累的检测。仅报告了一例弥散受限，但未对 ADC 图进行定量分析。
MRI 显示出独特的特征，可将阴道和子宫淋巴瘤与更常见的癌区分开来，并将术后改变与肿瘤复发区分开来。它表现出明显的弥散受限模式，ADC 值低于癌和术后改变。
