原发于子宫及双侧卵巢弥漫大B细胞淋巴瘤一例

doi:10.12280/gjszjk.20220356

摘要/Abstract

摘要：

子宫及卵巢弥漫大B细胞淋巴瘤临床罕见，临床及辅助检查常无特异性表现，常需术后病理确诊，免疫组织化学检查进一步证实。回顾分析1例原发于子宫及双侧卵巢弥漫大B细胞淋巴瘤的临床资料，该患者为围绝经期女性，因盆腔肿物行经腹全子宫+双侧附件切除术+大网膜切除术，术后病理确诊为弥漫大B细胞淋巴瘤，术后予利妥昔单抗、环磷酰胺、长春新碱、多柔比星和泼尼松联合化疗6个周期，化疗后6个月未见复发。

关键词: 淋巴瘤，大B细胞，弥漫性, 子宫, 卵巢, 诊断, 病例报告

Abstract:

Diffuse large B-cell lymphoma (DLBCL) of the uterus and ovary is rare in clinic. The clinical and auxiliary examination usually have no special manifestations. The postoperative pathology and immunohistochemistry can confirm the diagnosis. The clinical data of one case of DLBCL in uterus and bilateral ovaries were retrospectively analyzed. The patient was a perimenopausal female who underwent abdominal hysterectomy, bilateral adnexectomy and greater omentectomy due to pelvic mass. The definite diagnosis of DLBCL was made by the pathology after surgery. The chemotherapy with rituximab, cyclophosphamide, vincristine, doxorubicin and prednisone was given for 6 cycles after surgery, and no recurrence was observed within 6 months after chemotherapy.

Key words: Lymphoma, large B-cell, diffuse, Uterus, Ovary, Diagnosis, Case reports

宋晓平, 奚秋萍, 朱晓研. 原发于子宫及双侧卵巢弥漫大B细胞淋巴瘤一例[J]. 国际生殖健康/计划生育杂志, 2023, 42(2): 122-126.

SONG Xiao-ping, XI Qiu-ping, ZHU Xiao-yan. A Case of Diffuse Large B-Cell Lymphoma Originating from Uterus and Bilateral Ovaries[J]. Journal of International Reproductive Health/Family Planning, 2023, 42(2): 122-126.

图/表 3

图1 患者腹部CT图注:A为CT平扫可见腹盆腔内巨大占位;B为CT增强后可见肿物不均匀强化,其内可见多发细小血管影。

图2 患者盆腔MRI平扫及增强图注：A为矢状位见子宫增大，宫颈后方见一团块样影；B为双侧附件区团块影，呈T2-SPAIR高信号；C箭头处为宫颈后缘团块状软组织灶，呈T1WI等信号；D为两侧附件区团块状软组织灶，呈T1WI等信号；E、F为宫颈后方及双侧附件区团块，弥散明显受限。

图3 肿瘤病理图（HE染色×100）注：右侧卵巢结构破坏，肿瘤细胞圆形增大，增生活跃呈弥漫性浸润，核仁明显，细胞质丰富。

参考文献 24

[1]	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. doi: 10.3322/caac.21492. doi: 10.3322/caac.21492 URL
[2]	Latteri MA, Cipolla C, Gebbia V, et al. Primary extranodal non-Hodgkin lymphomas of the uterus and the breast: report of three cases[J]. Eur J Surg Oncol, 1995, 21(4):432-434. doi: 10.1016/s0748-7983(95)92945-2. doi: 10.1016/s0748-7983(95)92945-2 URL
[3]	Yildirim Y. Primary ovarian large B-cell lymphoma in patient with juvenile rheumatoid arthritis treated with low dose Methotrexate[J]. Gynecol Oncol, 2005, 97(1):249-252. doi: 10.1016/j.ygyno.2004.12.035. doi: 10.1016/j.ygyno.2004.12.035 pmid: 15790469
[4]	Wang J, Kim D, Kang WJ, et al. Prognostic Value of Bone Marrow F-18 FDG Uptake in Patients with Advanced-Stage Diffuse Large B-Cell Lymphoma[J]. Nucl Med Mol Imaging, 2020, 54(1):28-34. doi: 10.1007/s13139-019-00630-w. doi: 10.1007/s13139-019-00630-w
[5]	Carbone PP, Kaplan HS, Musshoff K, et al. Report of the Committee on Hodgkin’s Disease Staging Classification[J]. Cancer Res, 1971, 31(11):1860-1861. pmid: 5121694
[6]	Nasioudis D, Kampaktsis PN, Frey M, et al. Primary lymphoma of the female genital tract: An analysis of 697 cases[J]. Gynecol Oncol, 2017, 145(2):305-309. doi: 10.1016/j.ygyno.2017.02.043. doi: S0090-8258(17)30164-6 pmid: 28284518
[7]	Zhou Y, Zhang C, Gong Y, et al. Primary diffuse large B-cell lymphoma of the fallopian tube treated with a combination of surgery and chemotherapy: Case report[J]. Medicine(Baltimore), 2021, 100(3):e24049. doi: 10.1097/MD.0000000000024049. doi: 10.1097/MD.0000000000024049
[8]	Yun J, Kim SJ, Won JH, et al. Clinical features and prognostic relevance of ovarian involvement in non-Hodgkin’s lymphoma: A Consortium for Improving Survival of Lymphoma(CISL) report[J]. Leuk Res, 2010, 34(9):1175-1179. doi: 10.1016/j.leukres.2010.02.010. doi: 10.1016/j.leukres.2010.02.010 URL
[9]	Li PC, Lim PQ, Hsu YH, et al. Ovarian Diffuse Large B-cell Lymphoma Initially Suspected Dysgerminoma Managed by Laparoscopic Staging Surgery[J]. Gynecol Minim Invasive Ther, 2020, 9(3):162-165. doi: 10.4103/GMIT.GMIT_79_19. doi: 10.4103/GMIT.GMIT_79_19 URL
[10]	Salem U, Menias CO, Shaaban A, et al. Hematopoietic tumors of the female genital system: imaging features with pathologic correlation[J]. Abdom Imaging, 2014, 39(4):922-934. doi: 10.1007/s00261-014-0102-4. doi: 10.1007/s00261-014-0102-4 pmid: 24590396
[11]	Kasai M, Ichimura T, Murakami M, et al. Two cases of uterine malignant lymphoma diagnosed by needle biopsy[J]. J Obstet Gynaecol Res, 2015, 41(10):1664-1668. doi: 10.1111/jog.12759. doi: 10.1111/jog.12759 URL
[12]	Zhao L, Ma Q, Wang Q, et al. Primary diffuse large B cell lymphoma arising from a leiomyoma of the uterine corpus[J]. Diagn Pathol, 2016, 11:9. doi: 10.1186/s13000-016-0464-8. doi: 10.1186/s13000-016-0464-8 pmid: 26791260
[13]	Du E, Qu X, Xu W, et al. Primary female genital system lymphoma complicated by a recurrent mucinous borderline ovarian tumor: a case report and review of the literature[J]. BMC Womens Health, 2021, 21(1):420. doi: 10.1186/s12905-021-01568-y. doi: 10.1186/s12905-021-01568-y pmid: 34922516
[14]	董朝玉, 胡红文, 岳红萍, 等. 原发于子宫内弥漫性大B细胞淋巴瘤1例[J]. 疑难病杂志, 2021, 20(3):292-293. doi: 10.3969/j.issn.1671-6450.2021.03.018. doi: 10.3969/j.issn.1671-6450.2021.03.018
[15]	潘晗, 王满香, 陈长春. 卵巢弥漫性大B细胞淋巴瘤1例并CT影像分析[J]. 中国临床医学影像杂志, 2021, 32(1):74-75. doi: 10.12117/jccmi.2021.01.022. doi: 10.12117/jccmi.2021.01.022
[16]	董鹏, 林元强, 滕登科, 等. 子宫弥漫性大B细胞淋巴瘤常规超声及超声造影表现一例[J]. 中华医学超声杂志(电子版), 2020, 17(3):287-289. doi: 10.3877/cma.j.issn.1672-6448.2020.03.016. doi: 10.3877/cma.j.issn.1672-6448.2020.03.016
[17]	Tyagi A, Abrari A, Mukherjee U. Primary diffuse large B-cell lymphoma masquerading as uterine fibroid: A pathologistsf diagnosis[J]. J Cancer Res Ther, 2021, 17(1):288-290. doi: 10.4103/jcrt.JCRT_499_18. doi: 10.4103/jcrt.JCRT_499_18 pmid: 33723173
[18]	Fox H, More JR. Primary malignant lymphoma of the uterus[J]. J Clin Pathol, 1965, 18(6):723-728. doi: 10.1136/jcp.18.6.723. doi: 10.1136/jcp.18.6.723 pmid: 5844198
[19]	Iizuka N, Ikura Y, Fukuoka Y, et al. Malignant Lymphoma of the Ovary: A Diagnostic Pitfall of Intraoperative Consultation[J]. Int J Gynecol Pathol, 2020, 39(1):79-83. doi: 10.1097/PGP.0000000000000571. doi: 10.1097/PGP.0000000000000571 pmid: 31815893
[20]	Lenz G, Staudt LM. Aggressive lymphomas[J]. N Engl J Med, 2010, 362(15):1417-1429. doi: 10.1056/NEJMra0807082. doi: 10.1056/NEJMra0807082 URL
[21]	Luo B, He RQ, Peng ZG, et al. Unusual presentation of primary ovarian diffuse large B-cell lymphoma: a case report[J]. J Ovarian Res, 2022, 15(1):47. doi: 10.1186/s13048-022-00978-2. doi: 10.1186/s13048-022-00978-2 pmid: 35477468
[22]	Cubo AM, Soto ZM, Cruz MÁ, et al. Primary diffuse large B cell lymphoma of the uterine cervix successfully treated by combined chemotherapy alone: A case report[J]. Medicine(Baltimore), 2017, 96(19):e6846. doi: 10.1097/MD.0000000000006846. doi: 10.1097/MD.0000000000006846
[23]	Ishii Y, Fujisawa S, Ando T, et al. Primary uterine lymphoma: The Yokohama Cooperative Study Group for Hematology (YACHT) study[J]. Asia Pac J Clin Oncol, 2018, 14(5):e455-e459. doi: 10.1111/ajco.13049. doi: 10.1111/ajco.13049 URL
[24]	Ensor AM, Sanchez CG, Ensor JE, et al. Primary diffuse large B-cell lymphoma of the uterus: A SEER databaseanalysis[J]. Medicine(Baltimore), 2021, 100(40):e27359. doi:10.1097/MD.0000000000027359. doi: 10.1097/MD.0000000000027359