REVIEW ARTICLE
Primary follicular lymphoma of the cervix uteri: a review
Aylin Fidan Korcum
&
Ihsan Karadogan
&
Gamze Aksu
&
Ayse Aralasmak
&
Gulgun Erdogan
Received: 2 April 2007 / Accepted: 2 June 2007 / Published online: 22 June 2007
#
Springer-Verlag 2007
Abstract Primary non-Hodgkin’s lymphoma of the cervix is
a rare disease, of which a subgroup of follicular lymphoma
constitutes only 8.5%. There is not an established treatment
protocol neither for primary cervical lymphoma nor for its
follicular subgroup. We presented a case with Ann Arbor
stage IEA (Extra-nodal involvement and absence of weight
loss, fever, night sweat) primary follicular lymphoma of the
cervix. She was treated with chemotherapy followed by pelvic
radiotherapy. Upon relapse with a nodal neck mass, she was
treated with rituximab alone. She remained well for 23
months after rituximab. In the 39 months of follow-up, there
was no evidence of disease. In the light of our case, we
reviewed the reported cases of primary follicular lymphoma
of the cervix while discussing their treatment protocols and
the cases of primary cervix lymphoma treated with rituximab.
Keywords Primary cervix lymphoma
.
Follicular
.
Radiotherapy
.
Chemotherapy
Introduction
Primary non-Hodgkin’s lymphoma (NHL) of the cervix is
extremely rare. Only 0.5% of extranodal lymphomas in
women are likely to originate in the female genital tract [1,
2]. Until now, more than 130 cases of primary NHL of the
cervix have been reported. The most common histological
subtype is diffuse large B-cell lymphoma [3]. Only 11 cases
with low-grade follicular lymphoma of the cervix were re-
ported comprising 8.5% of the primary cervix lymphomas
[2–9].
In the cervical lymphoma, the median age at presentation is
44 years, ranging from 27 to 80 years [5, 10]. The most
frequent complaint is abnormal vaginal bleeding [7]. Fever,
night sweats, and weight loss are usually not the features of
primary lymphoma of the cervix. Other gynecologic symp-
toms can occur including pelvic pain, postcoital bleeding,
postmenopausal bleeding, and dyspareunia [11–13]. Differ-
ential diagnosis of primary cervical lymphomas includes
benign inflammatory and malignant disease such as cervical
carcinomas, sarcomas, and lymphoma-like lesions [3, 14,
15]. For a definitive diagnosis, a deep cervical biopsy with
histopathological evaluations and immunophenotyping are
required [14, 15]. Because such located lymphomas are
subepithelial and unless there is ulceration and exfoliation,
Papanicolaou smear plays a very insignificant role in the
diagnosis of cervical lymphoma [7]. Ann Arbor stage, size,
and extent of disease, age, number of extranodal sites, per-
formance status, serum lactate dehydrogenase (LDH) values,
and grade of lymphoma are significant prognostic features
[4, 6, 11, 16].
Because of the rarity, there is not an established treatment
protocol for primary NHL of the cervix. Radiotherapy,
chemotherapy, and surgery, either alone or in combination,
are the mainstay of treatment [10–12, 17, 18]. Some suggested
Ann Hematol (2007) 86:623–630
DOI 10.1007/s00277-007-0328-0
A. F. Korcum (*)
:
G. Aksu
Department of Radiation Oncology,
Akdeniz University, School of Medicine,
Antalya 07070, Turkey
e-mail: aylinf@hotmail.com
I. Karadogan
Department of Hematology,
Akdeniz University, School of Medicine,
Antalya 07070, Turkey
A. Aralasmak
Department of Radiology,
Akdeniz University, School of Medicine,
Antalya 07070, Turkey
G. Erdogan
Department of Pathology,
Akdeniz University, School of Medicine,
Antalya 07070, Turkey