Cancer Genomics

Biography

Biography: Azadeh Memarian

Abstract

Clinical symptoms of female genital tract lymphoma are often non-specific and mimic other more common gynecological malignancies. Diagnosis can only be confirmed by histology. A 48-year-old multiparous woman was referred to the gynecology clinic because of enlarged myomatous uterus and persistent heavy vaginal bleeding. She underwent a subtotal hysterectomy and unilateral salpingo-oophorectomy in a Hospital in Yazd (Iran). Intraoperatively severe bleeding occurred and dense cervical adhesions to peripheral tissues were found. Pathology report indicated benign leiomyoma. After a few months, an abdomino-pelvic CT scan was performed because of flank pain that revealed bilateral hydronephrosis. The patient was referred to the Gynecology Oncology clinic of Bahman hospital in Tehran. Pelvic and rectovaginal exam and colposcopy were performed. Biopsy report was negative, after which mycobacterium tuberculosis test showed negative results. Under general anesthesia, multiple deep cervical biopsies revealed no malignancy again. The slides were reviewed by another “referral” pathologist who reported a typical lymphoid infiltration, consistent with malignant lympho-proliferative disorder in parametrial biopsies. Immunohistochemistry confirmed the diagnosis. The stony appearance of the cervix and a concomitant frozen pelvis strongly supported the diagnosis of cervical malignancy. The role of gynecological examination in the diagnosis of genital cancer is essential. When frozen pelvis and a fixed stony cervix are present, it is necessary to perform multiple deep biopsies in spite of previous negative pathologies. Review of the slides by qualified pathologists can help achieve an accurate diagnosis. Despite histopathological errors, lymphoma should always be considered by pathologists, particularly in these unusual cases.