Vaginal Lymphoma: A Possible Cause of Genital Hemorrhage.

A 59-year-old patient complaining of vaginal bleeding and puruloid discharge was admitted to our gynecology department. Speculum examination showed a vaginal fungating necrotic ulcerated mass. There was no palpable lymphadenopathy or hepato-splenomegaly on physical examination. Transvaginal ultrasound and abdominopelvic computed tomography demonstrated a bulky vaginal mass approximately 5x4x3 cm in diameter involving the bladder and the rectovaginal septum. With the patient’s approval, a punch biopsy was performed and failed to establish the diagnosis (small and necrotic samples that were not representative of the lesion).

Histopathological diagnosis was obtained after a second biopsy performed under general anesthesia. Immunohistochemistry showed that tumor cells were positive for CD20, CD30, MUM1, and bcl-6 and were negative for bcl-2, EMA, CD10, and CD30 (Figure 1). The patient was diagnosed with primary vaginal diffuse large-B-cell non-Hodgkin lymphoma (NHL) and underwent 8 courses of rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone immunochemotherapy. Complete remission was achieved without any relapse at 18 months’ follow-up.

Figure 1

A) Grenz zone (arrows): CD20-positive immunoreactivity in neoplastic cells (25x). B: Immunohistochemical analysis of paraffin-embedded sections of the mass lesion showing tumor cells expressing the CD20 molecule (400x).

Primary vaginal NHL represents less than 1% of genital neoplasms [1,2,3]. Early and accurate diagnosis significantly influences the prognosis [4,5]. It should be considered in differential diagnosis of patients with vaginal bleeding. A deep biopsy may be required.

Ethics

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