B-CELL LYMPHOMA OF FEMALE REPRODUCTIVE TRACT: A MIND-BOGGLING MYSTERY OF A BOGGY UTERUS sejalgrover98@gmail.com

PE032

B-CELL LYMPHOMA OF FEMALE REPRODUCTIVE TRACT: A MIND-BOGGLING MYSTERY OF A BOGGY UTERUS

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India

Oral or Poster

In approximately one-third of patients, Non-Hodgkin's lymphoma (NHL) affects the extranodal regions, including the female genital tract, with an incidence rate ranging from 0.5 and 1.5%. NHL can occur in the ovary, corpus uteri, cervix, vagina, or vulva; the most frequent site in the gynaecological tract is under debate, although most authors consider it to be the ovary.

45 year old post- menopausal female presented with c/o pain in abdomen and fever with chills since 1 month. No h/o per vaginal discharge, altered bowel bladder habits. Previous h/o appendicectomy 20 years back On examination, abdomen was distended and diffusely tender with no palpable organomegaly. Per vaginal examination: mass palpable over left fornix, uterus enlarged 8-10 weeks. CA-125 : 58.30. CA19-9, CEA, AFP and beta hCG were within normal limits.

Patient was electively operated for Total abdominal hysterectomy with Bilateral salpingo-oophorectomy- 10x 10x 5 cm oval shaped complex with both solid and cystic components seen arising from left ovary. Post-op Histopathological examination- Diffuse large B- cell lymphoma involving myometrium, left ovary and fallopian tube. IHC markers - PAX5, CD10, BCL2, BCL6, CD20,CD5, CD45, PanCK, Alk1 all positive. Post-operatively, PET-CT done - multiple oblong pelvic and retroperitoneal nodes with no significant metabolism present Plan for further management: Hematology reference was taken and collectively, patient was advised regular follow up with R-CHOP chemotherapy regimen.

Some cases are different, others surprising, and few are totally mind-boggling. As surgeons, one must keep all differential diagnoses in mind while approaching any case.