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An Unusual Cause of Postmenopausal Bleeding

Wuntakal, Rekha MBBS, MD, DNB, MRCOG1; Janga, Deepa MD, MRCOG1; Satyanarayana, Durga MS, MRCOG2; Reynolds, Karina MD, FRCS, FRCOG2; Hollingworth, Antony MBChB, PhD, FRCS (Ed), FRCOG1

Journal of Lower Genital Tract Disease: April 2008 - Volume 12 - Issue 2 - p 130-133
doi: 10.1097/LGT.0b013e3181571ae2
Case Reports

Background. Non-Hodgkin lymphoma usually presents with lymphadenopathy, fever, night sweats, and weight loss. Postmenopausal vaginal bleeding is a cardinal symptom of carcinoma of the endometrium or cervix but not one of non-Hodgkin lymphoma. Clinical awareness of this unusual mode of presentation is important.

Case. We report a case of non-Hodgkin lymphoma in a 60-year-old woman, who presented primarily with postmenopausal bleeding. Clinical examination revealed a "thickened" area on the posterior vaginal wall. Repeated vaginal biopsies showed fibrosis and inflammatory tissue only. Immunohistochemistry revealed non-Hodgkin lymphoma. This case highlights the diagnostic challenges such a complex case presents.

Conclusion. This case not only represents a case of non-Hodgkin lymphoma with genital involvement but also highlights the importance of diagnosis and management of such complex cases.

Whilst postmenopausal bleeding is a common symptom it must be emphasized that malignancy of the endometrium remains uncommon and this diagnosis of Non Hodgkin's lymphoma is extremely rare.

1Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, London, UK, and 2Department of Gynaecological Oncology, St Bartholomew's Hospital, London, UK

Reprint requests to: Rekha Wuntakal, MBBS, MD, DNB, MRCOG, Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Leytonstone, London E11 1NR, UK. E-mail:

©2008The American Society for Colposcopy and Cervical Pathology