Title:The Adjunctive Value of Diffusion Weighted Imaging in Diagnosis and Follow Up of Uterovaginal Diffuse B-cell Lymphoma: A Case Report and Literature Review
Volume: 17
Author(s): Gehad A. Saleh, Reham Alghandour, Eman Y. Rashad, Ahmed M. Tawfik and Ali H. Elmokadem*
Affiliation:
- Diagnostic Radiology Department, Mansoura University, Mansoura,Egypt
Keywords:
Magnetic resonance imaging, diffusion weighted imaging, uterine, cervical, vaginal, lymphoma.
Abstract:
Background: Lymphoma of the female gynecologic tract is extremely rare. Typically,
lymphoma is managed nonsurgically unlike other non-lymphomatous malignant tumors raising the
importance of differentiation between both entities.
Case Presentation: We describe the Magnetic Resonance Imaging (MRI) features of a case of
uterovaginal diffuse large B-cell lymphoma in a 50-year-old postmenopausal woman emphasizing
Diffusion-Weighted Imaging (DWI) as a diagnostic and follow up tool. We reviewed the literature
regarding the diagnostic methods for female genital lymphoma. Forty-five cases, including our patient,
were reviewed with an age range from 22 to 85 years. Vaginal bleeding was the most common
presentation. The diagnosis was established by Papanicolaou smear, cervical biopsy (25/45),
endometrial biopsy (6/45), vaginal biopsy (2/45), pelvic mass biopsy (2/45), iliac LN biopsy (1/45)
and surgical diagnosis (8/45). Diffuse Large B-Cell Lymphomas (DLBCL) constitute the vast majority
of the cases (82%). The uterine cervix was involved at diagnosis in the majority of these cases
(68%), while the uterine body (42%) and vagina (28%) were less involved. Pelvic lymphadenopathy
was found in 15 cases, while extra genital lymphomatous infiltration in 13 cases. Sonographic
findings were nonspecific, while CT provided excellent data about extra-genital involvement.
Thirteen cases underwent pelvic MRI that displayed superior detection of disease extension and
parametric involvement. Diffusion restriction was reported only in one case without quantitative
analysis of ADC map.
Conclusion: MRI shows unique features that differentiate uterovaginal lymphoma from the much
more common carcinomas and discriminate post-operative changes from tumor recurrence. It exhibits
a marked restricted diffusion pattern with lower ADC values than carcinomas and post-operative
changes.
