Primary lymphoma of the female genital tract: radiological findings of a rare entity.
Number:27ESURABS0035
Type:Educational Electronic Presentation
Authors: Beatriz Rebelo, Mariana Horta, Teresa Margarida Cunha
Keywords:Lymphoma, Education, Ultrasound, MR, CT, Genital / Reproductive system female
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Educational objective

The purpose of this poster is to review the radiological features of primary gynecological lymphoma on computed tomography (CT) and magnetic resonance imaging (MRI). Those findings are discussed in detail for each anatomic subsection, including the ovary, uterus, cervix, and vagina. Vulvar and fallopian tube lymphoma are not included because of their exceedingly rare incidence.


Topic Review

Background

 

The majority of lymphomas of the female genital tract are secondary and due to

extranodal dissemination of a primary non-Hodgkin lymphoma (NHL).

Primary lymphomas of the female pelvis are extremely rare, accounting for 1-2% of all cases of extranodal lymphoma (1).

The uterine cervix is the most common primary site of lymphomatous involvement in the female genital tract, and the ovary is the most common secondary site of invasion (2, 3).

Most cases of primary lymphomas of the female pelvis are NHL, of which diffuse large B-cell lymphomas (DLBCL) are the most commonly seen (4).

The etiology and pathogenesis of primary genital tract NHL remain unknown.

The presenting symptoms of primary lymphoma of the pelvis are non-specific and depend on the site of involvement, tumour size and degree of...

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Figure 1 – Bilateral primary non-classifiable B-cell lymphoma of the ovaries. Pelvic MRI: axial T1WI (A), contrast-enhanced fat-saturated T1WI (B), T2WI (C), coronal T2WI and sagittal T2WI. Images show bilateral, solid, homogeneous adrenal masses, with low signal on T1WI, and intermediate signal intensity on T2WI (yellow arrows), displaying hyperintense septa (red arrowheads) and smooth walls. The masses displace the uterine body to the right (red arrow) and the iliac vessels laterally (yellow arrowhead). The masses have a mild and homogeneous enhancement after contrast administration, the septa showing marked enhancement. A small amount of ascites is present in the cul-de-sac both paracolic gutters. References: Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon/PT
Figure 2 – Primary NHL of the endometrium. Pelvic MRI, axial T1WI (A), T2WI (B), T2WI (C), coronal T2WI (D) and sagittal T2WI (E). Images show the filling of the endometrial cavity with a polypoid mass (arrow) with interior cystic portions (arrowhead). References: Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon/PT


Conclusions

The radiological presentation of lymphomas of the female pelvis is non-specific, making the distinction from more common malignancies challenging in the setting of a newly discovered pelvic mass.

Histologic confirmation remains the primary mode of definitive diagnosis for a patient with suspected pelvic lymphoma.

Nevertheless, some radiological features can alert to the possibility of lymphoma in the differential diagnosis.

Radiological findings that suggest haematologic malignancy include a well-circumscribed enlargement of the involved organ, with preservation of their structure, and without invading adjacent structures, unlike other tumours.

The malignant involvement tends to have homogeneous attenuation (CT) or signal intensity (MRI) and mild enhancement with contrast administration. The presence of necrosis is rare in the absence of...

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