Aggressive primary uterine non-Hodgkin's lymphoma presenting as acute kidney injury: a case report.

in BMC women's health by Rawan Al-Deeb, Ram Attaf, Yaman Saiouf, Baraa Mouzi, Assef Dayyoub

TLDR

  • A 66-year-old woman was diagnosed with primary cervical lymphoma, which is extremely rare. She presented with severe symptoms and was treated with diuretics, hemodialysis, and chemotherapy. Unfortunately, the condition deteriorated and she died.

Abstract

Primary malignant lymphoma of the cervix is an extremely rare condition, accounting for only 0.008% of all cervical tumors and 2% of female extranodal lymphomas. The most common histological subtype is diffuse large B-cell lymphoma. This malignancy is often asymptomatic in its early stages, but advanced cases may include systemic symptoms, pelvic discomfort, and vaginal bleeding. Diagnosis is challenging due to its nonspecific clinical presentation and similarity to other gynecological conditions. Imaging and immunohistochemistry play essential roles in diagnosis and staging. Treatment typically involves chemotherapy, with the standard CHOP regimen for Non-Hodgkin's lymphoma being the main treatment in most cases. To the best of our knowledge, this is the first case in the literature to describe acute kidney injury associated with the already rare entity of primary female genital tract lymphoma. A 66-year-old multiparous woman presented with severe headache, nausea, vomiting, and dizziness lasting three days, alongside systemic symptoms such as weight loss, lethargy, and night sweats. Imaging indicated bilateral hydronephrosis, ascites, and an enlarged uterus with a suspected tumor. Biopsy confirmed diffuse large B-cell lymphoma with immunohistochemical positivity for CD20 and negative CD3. The patient was classified as stage IV according to the Ann Arbor system. Initial treatment included diuretics, hemodialysis, and chemotherapy with a dose-reduced CHOP regimen due to atrial fibrillation and reduced cardiac ejection fraction. Despite initial improvements, the patient developed tumor lysis syndrome and meningeal infiltration. Her condition deteriorated after the second chemotherapy cycle, culminating in neutropenic fever, massive hemorrhage, and ultimately death. Our case highlights the diverse manifestations of the disease, including acute kidney injury secondary to bilateral hydronephrosis, a previously unreported complication. Early recognition is essential for optimal management. While chemotherapy remains the mainstay of treatment, the lack of standardized protocols underscores the need for further research. This case emphasizes the unpredictable nature of primary female genital tract lymphomas and their potential to cause systemic complications.

Overview

  • The study reports a rare case of primary malignant lymphoma of the cervix, specifically a diffuse large B-cell lymphoma, in a 66-year-old multiparous woman.
  • The patient presented with severe headache, nausea, vomiting, and dizziness alongside systemic symptoms, and was diagnosed with bilateral hydronephrosis, ascites, and an enlarged uterus with a suspected tumor.
  • The primary objective of this case study was to highlight the diverse manifestations of primary female genital tract lymphomas, including acute kidney injury secondary to bilateral hydronephrosis, a previously unreported complication.

Comparative Analysis & Findings

  • The patient was diagnosed with diffuse large B-cell lymphoma, which is the most common histological subtype of primary malignant lymphoma of the cervix.
  • Imaging and immunohistochemistry played essential roles in diagnosis and staging, as the patient's symptoms were nonspecific and similar to other gynecological conditions.
  • The patient was initially treated with diuretics, hemodialysis, and chemotherapy with a dose-reduced CHOP regimen due to atrial fibrillation and reduced cardiac ejection fraction, but the condition deteriorated after the second chemotherapy cycle, culminating in neutropenic fever, massive hemorrhage, and ultimately death.

Implications and Future Directions

  • This case highlights the need for further research on standardized protocols for treatment and management of primary female genital tract lymphomas.
  • Early recognition of the disease is essential for optimal management, and a high index of suspicion is necessary to diagnose the condition accurately.
  • The study underscores the unpredictable nature of primary female genital tract lymphomas and their potential to cause systemic complications, emphasizing the importance of comprehensive care and multidisciplinary treatment.
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