Intravascular large B-cell lymphoma involving mainly the uterus: report of a case using liquid-based cytology of the endometrium.
BACKGROUND
Intravascular lymphoma is a rare subtype of extranodal lymphoma. Most instances of the disease are of B-cell lineage. Diagnosis is difficult because of its nonspecific clinical signs, and many cases are diagnosed at autopsy. Uterine involvement is rare, and it is commonly manifested as genital bleeding. In this case, the chief complaint was fever, which is also very rare.


METHODS
A 62-year-old woman presented with fever of unknown origin. Computed tomography revealed no localized lesion except for swelling of the right internal iliac nodes. A cytologic smear of the endometrium by liquid-based cytology demonstrated malignant cells. Based on the curettage material, the lesion was diagnosed as an undifferentiated malignant tumor. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic/paraaortic lymphadenectomy revealed widely scattered lymphoma cells of B-cell lineage mainly in the vascular lumina of the uterus, right ovary and lymph nodes.


CONCLUSIONS
The final histologic type was established on the basis of the surgical material of hysterectomy. Diagnosis was difficult because of prominent cellular atypia and rare location of the tumor. Immunocytochemical examination of liquid-based samples can lead to a correct diagnosis of malignant lymphoma, even at the stage of endometrial cytologic examination.
Department of Obstetrics and Gynecology, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kitatakamatu-machi, Miyazaki City, Miyazaki 880-8510, Japan. kuromai1217@yahoo.co.jp
Arisa
A
Fujiwara
Shiho
S
Nagayama
Satoshi
S
Amada
Tomihiro
T
Shimamoto
Yoshiya
Y
Shimao
Tohru
T
Hayashi
D002449:Cell Aggregation; D003584:Cytological Techniques / Q000379:methods*; D003937:Diagnosis, Differential; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000473:pathology; D004717:Endometrium / Q000098:blood supply* / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000473:pathology*; D008875:Middle Aged; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology; D010053:Ovary / Q000473:pathology; D017154:Stromal Cells / Q000473:pathology; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000473:pathology*