State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Hematology Department of the First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Medicine (Baltimore). 2022 Jul 29;101(30):e29353. doi: 10.1097/MD.0000000000029353.
Primary extranodal marginal zone B-cell lymphomas of the fallopian tube is extremely rare. It is a great challenge for fertility and gynecology doctors to manage such cases and also fulfil the reproductive demands of these young women.
A 30-year-old woman consulted for a 5-year primary infertility.
According to the Ann Arbor staging system, a stage IE extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue lymphoma was diagnosed for this patient based on tumor pathology, bone marrow biopsy, hysteroscopy and whole-body positron emission tomography imaging. She also had endometriosis based on laparoscopy.
The patient underwent a laparoscopic bilateral salpingostomy without additional surgery or radiotherapy and chemotherapy for fertility preservation, and received 5 months of long-acting gonadotropin releasing hormone agonist treatment for endometriosis.
Two years after the surgery, the patient delivered a healthy neonate through in vitro fertilization-embryo transfer procedures. The patient is now 3 years post-op and 1 year post-delivery, long-term follow-up suggested that the patient remained cancer-free up till now.
More care should be taken when the newly diagnosed mass is combined with a rather high serum CA-125 level. Although endometriosis and ovarian cancer are more common, lymphoma cannot be ruled out.
输卵管原发性结外黏膜边缘区 B 细胞淋巴瘤极为罕见。对于生育和妇科医生来说,管理此类病例并满足这些年轻女性的生殖需求是一项巨大的挑战。
一位 30 岁的女性因原发性不孕 5 年来就诊。
根据 Ann Arbor 分期系统,基于肿瘤病理学、骨髓活检、宫腔镜和全身正电子发射断层扫描成像,该患者被诊断为 IE 期结外黏膜边缘区 B 细胞淋巴瘤,黏膜相关淋巴组织淋巴瘤。根据腹腔镜检查,她还患有子宫内膜异位症。
为了保留生育能力,该患者接受了腹腔镜双侧输卵管造口术,未进行额外的手术或放化疗,同时还接受了 5 个月的长效促性腺激素释放激素激动剂治疗子宫内膜异位症。
手术后 2 年,该患者通过体外受精-胚胎移植程序分娩了一名健康的新生儿。患者目前术后 3 年,产后 1 年,长期随访提示患者至今仍无癌症。
当新诊断的肿块伴有较高的血清 CA-125 水平时,应更加小心。虽然子宫内膜异位症和卵巢癌更为常见,但不能排除淋巴瘤的可能性。