Background:
Lymphoma of the female gynecologic tract is extremely rare. Typically,
lymphoma is managed non surgically unlike other non-lymphomatous malignant
tumors raising the importance to differentiate between both entities.
Case report:
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 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 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.
Conclusion:
MRI shows unique features that help to 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.
Isolated Dysphagia in a Patient with Medial Medullary Infarction – Effects of Evidence-Based Dysphagia Therapy: A Case Report
