title: Diffuse large B-cell lymphoma of the uterus suspected of having transformed from a marginal zone B-cell lymphoma harboring trisomy 18: a case report and review of the literature.
abstract: The patient was a 72-year-old female with the chief complaint of abdominal fullness. A giant primary myoma of the uterine cervix was suspected, and total hysterectomy was performed. Based on a postoperative histopathological examination of the tumor a diagnosis of diffuse large B-cell lymphoma (DLBCL) was made in the uterus and a mass in the greater omentum was diagnosed as a marginal zone B-cell lymphoma (MZBCL). No flow-cytometry studies or chromosome or gene examinations were performed on a fresh specimen. The results of an examination of a paraffin block histopathology specimen by fluorescence in-situ hybridization (FISH) showed no mucosa associated lymphoid tissue lymphoma translocation gene 1 (MALT1) (18q21.1), B-cell lymphoma 2 (BCL2) (18q21.3), or BCL6 (3q27) split signals in either the uterus or the greater omentum, however, trisomy 18 was detected in approximately 50%-70% of the tumor cells in both the uterus and the greater omentum. Trisomy 18 was present in around 15-33% of the DLBCL cells and MZBCL cells. These findings suggested a strong possibility that the tumor cells in the uterus and greater omentum were the same clone and that transformation from MZBCL to DLBCL had occurred. Since DLBCLs that result from a transformation usually have a worse outcome than de novo DLBCLs, even when a DLBCL seems to have originated in the uterus the surrounding tissue should always be examined, and caution should be exercised in regard to transformation from a low-grade B-cell lymphoma to a DLBCL.
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Urayasu, Japan.
authors.forename: Kei-Ji
authors.initials: KJ
authors.lastname: Sugimoto
authors.forename: Hidenori
authors.initials: H
authors.lastname: Imai
authors.forename: Asami
authors.initials: A
authors.lastname: Shimada
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Wakabayashi
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Sekiguchi
authors.forename: Noriko
authors.initials: N
authors.lastname: Nakamura
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sawada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Izumi
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ota
authors.forename: Norio
authors.initials: N
authors.lastname: Komatsu
authors.forename: Masaaki
authors.initials: M
authors.lastname: Noguchi
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D002887:Chromosomes, Human, Pair 18; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D018442:Lymphoma, B-Cell, Marginal Zone / Q000737:chemistry / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D016403:Lymphoma, Large B-Cell, Diffuse / Q000737:chemistry / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D009852:Omentum / Q000737:chemistry / Q000473:pathology* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000737:chemistry / Q000235:genetics* / Q000473:pathology* / Q000601:surgery; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D014314:Trisomy; D014594:Uterine Neoplasms / Q000737:chemistry / Q000235:genetics* / Q000473:pathology* / Q000601:surgery
chemical_list: D014408:Biomarkers, Tumor
keywords: Marginal zone lymphoma; diffuse large B-cell lymphoma; greater omentum; transformation; trisomy 18; uterus