Spindle cell variant of diffuse large B-cell lymphoma of the uterine cervix; a case report of a rare entity and a potential pitfall

[摘要] Introduction: Primary lymphomas involving the uterine cervix are rare. The spindle cell variant ofdiffuse large B-cell lymphoma (sDLBCL) occurring in the uterine cervix is extremely rare.Case report: This is a 57-year-old woman, who presented with acute retention of urine. Clinicalexamination revealed a lesion obliterating the external os of the cervix. The ultrasound scan (USS)and contrast enhanced computerised tomography (CE-CT) confirmed the presence of a cervical masswith parametrial invasion. The cervical biopsy revealed an invasive tumour with a spindle cellmorphology. Positive staining of tumour cells with immunohistochemical markers LCA and CD20 anda Ki-67 proliferation index of >90% was compatible with the sDLBCL. BCL6 positivity along withnegative CD10 and IRF4/MUM1 was compatible with the germinal centre B-cell subtype. The bonemarrow biopsy showed a tumour with similar immunomorphological features. The lymphoma wasstage IV according to the Ann Arbor lymphoma staging system.Discussion and conclusion: Owing to its rarity and histomorphology, the sDLBCL is often misdiagnosedas carcinosarcoma, melanoma or sarcoma on routine haematoxylin and eosin (H&E) stained sections.Therefore, appropriate immunohistochemical analysis is mandatory to distinguish sDLBCL fromtumours with similar histomorphology. The prognosis of this rare tumour is not well- documented.Eight months after the initial presentation, the patient has completed six cycles of R-CHOP and isawaiting radiotherapy.

[学科分类] 生理学与病理学

[关键词] diffuse large B-cell lymphoma;spindle cell variant;sarcomatoid;rare variants;cervix