Background

Lymphomas involving gynecologic organs often occur in the ovaries, and uterine cervix. Uterine corpus, vagina, and vulva are less common locations involved. Although female genital tract lymphomas are uncommon, it is important for the gynecologists and pathologists to be aware of this entity as it potentially could be the first presenting location of lymphoma or involved secondarily.

Methods

Pathology of lymphomas first diagnosed in and secondarily involving gynecologic organs from January 2005 to January 2024 were retrieved from our institution's pathology databases, and their clinicopathological features were reviewed.

Results

A total of 19 patients with lymphomas involving the gynecological organs were identified with 17 patients being first-time diagnosed with lymphomas on gynecologic surgical pathology specimens and 2 patients with prior history of lymphoma. The average age of patients with lymphoma diagnosed initially in the gynecologic tract was 59.2 years (range 20-83 years). The two patients with prior lymphoma histories had diffuse large B-cell lymphomas (DLBCL) with one transformed from prior retroperitoneal low-grade follicular lymphoma. The cervix was the most frequent location of first-time diagnosed lymphomas, comprising 8 of 17 specimens (47%), followed by bilateral ovaries and fallopian tubes (41%), endomyometrium (12%), and vagina (6%). The types of first diagnosed gynecologic lymphomas were DLBCL (65%), follicular lymphoma (18%), lymphoplasmacytic lymphoma (6%), Burkitt lymphoma (6%) and extranodal marginal zone B-cell lymphoma (MZBCL) (6%). When the criteria of defining primary gynecologic lymphomas were applied, 7 of 17 first-time diagnosed lymphomas in the gynecologic tract were actually primary gynecologic lymphomas without distant disease, peripheral blood or bone marrow involvement, including 5 cervical primary, one endometrial primary and one vaginal primary lymphoma.

Conclusion

Our study confirmed that the most common lymphomas involving the gynecologic tract were DLBCL and follicular lymphoma, with rare incidence of Burkitt lymphoma, extranodal MZBCL and lymphoplasmacytic lymphoma. Misdiagnosing gynecologic lymphomas as high-grade/undifferentiated carcinoma or sarcoma is a real risk for surgical pathologist, especially during frozen sections.