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In the largest published series, of a total of 697 cases of primary lymphomas of the female genital tract, only 149 (21.4%) had originated in the cervix.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Most of these cases were diffuse large B-cell lymphomas (72.1%); none of them showed evidence of transformation from a follicular lymphoma.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 48-year-old woman, with no substance abuse or pathological history of interest, who came to the emergency department due to a one-month history of bleeding during intercourse. Gynaecological examination showed a tumour located on the posterior lip of the cervix, 2<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm, from which a punch biopsy was performed. A dense lymphocytic infiltrate with a diffuse pattern and B phenotype was observed, which suggested a differential diagnosis between a lymphoproliferative process (primary cervical or systemic with secondary involvement of the cervix) or atypical lymphoid hyperplasia (ALH), therefore a complete haematological study and an extensive biopsy of the lesion were recommended. The complete blood count performed was normal, as well as the bone marrow aspirate and biopsy. A hypermetabolic mass was observed in the uterine cervix with extension to the vagina in the PET-CT scan, with a maximum SUV of 12. No other nodal or extranodal lesions were detected.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In order to have a large biopsy, a cervical conisation was performed, showing a B-cell proliferation with areas of diffuse pattern and vaguely nodular areas, consisting of abundant large blast cells with vesicular nuclei and prominent eosinophilic nucleoli. This population was accompanied by small-medium lymphocytes with irregular nuclei. Lymphoid proliferation extended to deep planes, without involvement of the cervical mucosa. Immunohistochemistry showed positive results for CD20, BCL6 and BCL2, while CD3, CD10 and MUM1 were not detected. The proliferation index (Ki67) was greater than 40%. Dendritic follicular cells (CD23 and CD21 positive) were identified in vaguely nodular areas. The molecular biology study detected a clonal rearrangement of the <span class="elsevierStyleItalic">IgK</span> gene and a translocation of the <span class="elsevierStyleItalic">BCL2</span> gene by fluorescence <span class="elsevierStyleItalic">in situ</span> hybridisation. All of these findings were consistent with a diffuse large B-cell lymphoma, probably transformed from a previous stage IE follicular lymphoma.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The serological study was negative (hepatitis B and <span class="elsevierStyleSmallCaps">C</span> virus, HTLV I, II and human immunodeficiency virus), no human papillomavirus infection was detected. Biochemistry was normal, including LDH. The ECOG (<span class="elsevierStyleItalic">Eastern Cooperative Oncology Group</span>) scale was 0, and the patient was classified as stage IE, IPI (International Prognosis Index) 0, and began treatment with R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Primary lymphomas of the cervix are very rare, so if there is an atypical lymphocytic infiltrate at this site, secondary involvement of a systemic lymphoma must be ruled out first. This requires a complete haematological study that includes imaging tests such as PET-CT. On the other hand, it is also necessary to make a differential diagnosis with atypical lymphoid hyperplasia (pseudolymphoma).<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This differential diagnosis is based primarily on morphological characteristics. Thus, the presence of a deep infiltrate, the monomorphic appearance with a prevalence of B lymphocytes, a preserved mucosa and the absence of reactive lymphoid follicles are suggestive of lymphoma. In this context, evidence of a clonal rearrangement of immunoglobulin genes is not useful, since about 50% of ALHs may have clonal characteristics.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Due to the low incidence of this entity, there are no standardised treatment guidelines for these patients. In most cases, surgical treatment alone is chosen, while in other cases immunochemotherapy with or without radiotherapy is decided upon.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, primary cervical lymphoma is a very rare and difficult to diagnose condition that requires detailed clinical and radiological studies, as well as an extensive biopsy to rule out secondary involvement and pseudolymphomas.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pons L, Carballas E, Tapia G. Linfoma difuso de células grandes B primario de cérvix. Med Clin (Barc). 2021;156:530–531.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of non-Hodgkin's lymphoma: comparison of nodal and extra-nodal sites" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Newton" 1 => "J. Ferlay" 2 => "V. Beral" 3 => "S.S. 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Zukerberg" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PAS.0b013e3181cc4f12" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2010" "volumen" => "34" "paginaInicial" => "161" "paginaFinal" => "168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20087162" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000010/v1_202105151030/S238702062100200X/v1_202105151030/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000010/v1_202105151030/S238702062100200X/v1_202105151030/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062100200X?idApp=UINPBA00004N" ]
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Vol. 156. Issue 10.
Pages 530-531 (May 2021)
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Vol. 156. Issue 10.
Pages 530-531 (May 2021)
Letter to the Editor
Primary diffuse large B cell lymphoma of the cervix
Linfoma difuso de células grandes B primario de cérvix
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