具有梭形细胞形态学特征的阴道大B细胞淋巴瘤

　　Large B cell Lymphoma of the vagina with spindle-cell morphology

M.E. Graham¹, T.K. Madhuri¹, B. Haagsma², A. Tailor¹, S. Butler-Manuel¹

¹Department of GynaeOncology,²Department of Histopathology, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK

Introduction:Non-Hodgkin's lymphomas(NHL) involve the female genital tract, however rarely is it the primary site of malignancy. We present a case of a 38 year old woman who developed a primary vaginal NHL. This case highlights the need to consider NHL in the differential diagnosis of vaginal masses.

Case summary:A 38 yr old woman was referred after finding a raised area on her vagina. Two small punch biopsies showed changes compatible with HPV. 3 months later at review, the lesion had grown to form a definite palpable lump. A wedge biopsy, EUA with sigmoidoscopy was performed which was normal. Histology revealed a large B cell lymphoma with a rare spindle cell pattern. Pelvic MRI showed a poorly defined mass (7cm x 8.5cm x 7.8cm) along the left vaginal wall extending into the left hemi-pelvis and suspicious of uterine involvement. There was no pelvic lymphadenopathy or metastatic disease. The final diagnosis was a bulky stage 1c high grade vaginal NHL and treatment was commenced with 6 cycles of CHOP chemotherapy and radical radiotherapy and she remains well to date.

Discussion:Lymphomas of the genital tract are rare but should be considered in women of all ages presenting with an atypical mass. Pelvic MRI imaging and biopsy at an early stage will prevent delayed diagnosis. Spindle cells are formed during abnormal mitosis, leading to a malignant change. An awareness of vaginal NHL is necessary in order to prevent potential delay or misdiagnosis which leading to inappropriate treatment.

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