Ultrasonic manifestations of primary female genital system lymphoma

Abstract

Objective To explore the ultrasonic manifestations of primary female genital system lymphoma (PFGSL), and to provide guidance for the ultrasonic diagnosis of this disease. Methods A total of 15 patients with PFGSL who underwent surgical treatment in West China Second University Hospital, Sichuan University from September 1, 2008 to July 31, 2016 and were finally diagnosed as PFGSL by postoperative histopathological examination were selected as the study subjects by retrospective analysis method. All the 15 patients received preoperative ultrasound examinations. The clinical manifestations, preoperative ultrasonography results and postoperative histopathological examination results of those 15 patients were analyzed. The count data, such as proportions of different types of lesions were expressed by rate (%). This study was in line with the requirements of the World Medical Association Declaration of Helsinki revised in 2013. Results The analysis results of those 15 patients were as follows. ①Clinical manifestations: the main clinical manifestations of 10 cases of patients with primary ovarian lymphoma were pelvic mass or ascites. Three cases of patients with primary cervical lymphoma and one case of primary endometrial lymphoma were mainly characterized by irregular vaginal bleeding. One case of patient with primary vaginal lymphoma was mainly characterized by perineal discomfort and irregular vaginal bleeding. ②Preoperative ultrasonography results: one patient with primary vaginal lymphoma failed to find space-occupying lesions, and the other 14 patients all found lesions. A total of 20 lesions were detected, including 16 lesions, 3 lesions and 1 lesion in patients with primary ovarian, cervical and endometrial lymphoma, respectively. Ultrasound examinations of patients with primary ovarian lymphoma showed peritoneal thickening and metastatic nodules. And the features of ultrasound sonogram of metastatic nodules and primary tumors were close, all of which were solid weak echoes with abundant blood flow signals. And 62.5% (10/16) lesions in patients with primary ovarian lymphoma had cystic changes, and their blood flow signals were sparser compared to solid lesions. Ultrasound examination of patients with primary cervical and endometrial lymphoma showed slightly weak echoes in the uterus with relatively abundant blood flow signals. ③Postoperative histopathological examination results: all those 15 subjects were finally diagnosed as PFGSL, belonging to non-Hodgkin lymphoma (NHL), including 13 cases of B-cell NHL and 2 cases of T-cell NHL (all of them were primary ovarian lymphoma). ④Surgical results: 21 lesions were removed, of which 57.1% (12/21) were gray white and fishy solid masses, and 42.9% (9/21) lesions were associated with cystic changes. Conclusions The clinical and ultrasonic manifestations of PFGSL are related to the invasion site of PFGSL, and B-cell-derived tumors account for the majority of PFGSL. The ultrasound images of PFGSL have certain characteristics and may provide a reference for the diagnosis and treatment of the disease. Key words: Genital neoplasms, female; Lymphoma; Ultrasonography; Lymphoma, non-Hodgkin; Diagnosis, differential; Female