title: Institutional review of primary non-hodgkin lymphoma of the female genital tract: a 33-year experience.
abstract: OBJECTIVE
  The aim of this is to provide an updated review of the literature and to report our institutional experience with this rare gynecologic malignancy.
  
  
  METHODS
  The medical records of patients with diagnosis of non-Hodgkin lymphoma of the female genital tract from 1980 to 2013 at the Yale-New Haven Hospital were reviewed retrospectively. Histological classification and staging were determined by the World Health Organization and Ann Arbor systems, respectively. Kaplan-Meier was used to calculate the survival.
  
  
  RESULTS
  There were 36 patients with diagnosis of non-Hodgkin lymphoma of the female genital tract and followed for a median of 61 months (0-361 months). The median age of diagnosis was 44 years (19-87 years), and 76% (n = 28) were classified as stage IV.Of these, 4 patients were asymptomatic on presentation, and 13 were identified incidentally during surgery/radiography (n = 9), on prenatal ultrasound (n = 1), and on Papanicolaou test (n = 3). The location of the disease included the ovary (n = 6), uterine corpus and cervix (n= 9), vagina (n = 1), a pelvic mass (n = 7), isolated pelvic/para-aortic lymph nodes (n = 3), and/or multiple sites (n = 9). There were 6 cases that were concomitant with other gynecologic malignancies.Diffuse large B-cell lymphoma (n= 18) was the most common histologic type. A total of 28 patients underwent surgery. Combination chemotherapy was used in 34 patients, with concomitant radiation therapy in 7 and stem cell transplantation in 3. A total of 5 patients had recurrent disease.The overall median survival from the diagnosis of lymphoma was 70 months (0.3-361 months) with a 91% 1-year survival, 86% 5-year survival, and a 79% 10-year survival.
  
  
  CONCLUSIONS
  Our report is the largest published single-institution experience of this disease. It demonstrates a more favorable prognosis and proposes that with early diagnosis and appropriate therapy, radical gynecologic surgery can be avoided.
authors.affiliation: *Yale-New Haven Hospital; †Yale University School of Medicine, New Haven, CT; and ‡John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ.
authors.forename: Asima Kaleem
authors.initials: AK
authors.lastname: Ahmad
authors.forename: Pei
authors.initials: P
authors.lastname: Hui
authors.forename: Babak
authors.initials: B
authors.lastname: Litkouhi
authors.forename: Masoud
authors.initials: M
authors.lastname: Azodi
authors.forename: Thomas
authors.initials: T
authors.lastname: Rutherford
authors.forename: Shirley
authors.initials: S
authors.lastname: McCarthy
authors.forename: Mina LuQing
authors.initials: ML
authors.lastname: Xu
authors.forename: Peter E
authors.initials: PE
authors.lastname: Schwartz
authors.forename: Elena
authors.initials: E
authors.lastname: Ratner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001761:Bleomycin / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005833:Genital Neoplasms, Female / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D013509:Gynecologic Surgical Procedures / Q000706:statistics & numerical data; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D013713:Teniposide / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D003561:Cytarabine; D001761:Bleomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D013713:Teniposide; D011239:Prednisolone; D011241:Prednisone