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Primary Vaginal NonHodgkin Lymphoma: Gynecologic Diagnosis of a Hematologic Malignancy

Ragupathy, Kalpana MRCOG; Bappa, Lawal MRCOG

Journal of Lower Genital Tract Disease: July 2013 - Volume 17 - Issue 3 - p 326–329
doi: 10.1097/LGT.0b013e31826ca366
Case Reports

Background: Non–Hodgkin lymphoma (NHL) predominantly affects the lymph nodes and bone marrow. Extranodal sites of NHL include the thymus, spleen, and Waldeyer ring. Very rarely NHL affects the gynecologic tract (<0.5%), and secondary spread is more common than primary involvement.

Case Report: We report a case of primary NHL of the vagina diagnosed in a young woman who presented with a painless vaginal mass. Although the initial clinical diagnosis was that of an inflamed Gartner duct, atypical presentation of the mass prompted further imaging, such as pelvic ultrasonographic imaging and magnetic resonance imaging. The latter showed presence of similar masses in the posterior cervix and vagina, and after a multidisciplinary team discussion, biopsy of the mass showed primary vaginal NHL. Subsequently, we referred her to hematologists who commenced chemotherapy. Only 57 cases of primary vaginal NHL have been reported in the literature, and our case elucidates the workup of atypical vaginal masses to facilitate a diagnosis and appropriate management.

Conclusions: NHL of the female genital tract is uncommon. Early diagnosis translates to better survival for these women because extranodal NHLs bear a worse prognosis when compared with that of nodal lymphomas mainly owing to delay in diagnosis.

Primary vaginal non-Hodgkin lymphoma is rare but to be considered in investigation of an atypical vaginal mass because prognosis is better with early diagnosis.

Department of Obstetrics and Gynaecology, Doncaster Royal Infirmary, Doncaster, South Yorkshire, United Kingdom

Reprint requests to: Kalpana Ragupathy, MRCOG, Department of Obstetrics and Gynaecology, Doncaster Royal Infirmary, Armthorpe Rd, Doncaster, South Yorkshire United Kingdom. E-mail: kalpanaraghu@yahoo.co.uk

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology