Magnetic resonance imaging of primary lymphoma of the cervix

Abstract

Although uterus and cervix infiltration is a frequent finding in the later stages of lymphomatous disease, primary lymphoma of the cervix is very uncommon; however, this entity can occasionally be distinguished from cervical carcinoma by means of MRI. This is an important fact as treatment and prognosis differ between these neoplasms. We present a case of primary cervical lymphoma studied with high-field (1.5 T) MRI and we make an extensive review of the literature. The cervical mass was found in a routine pelvic examination in a patient with no previous history of gynecologic disorders. This is an uncommon way of presentation of this disease. T2-weighted turbo spin-echo (TSE) sequences in the axial, sagittal, and coronal planes, and T1-weighted SE pre- and post-contrast images, were obtained. The lack of involvement of the mucosa, as well as sparing of cervical stroma and uterine junctional zone, are the most important findings to differentiate cervical lymphoma from carcinoma, and are best evaluated with T2 TSE sequences. Post-contrast images help to delineate the extent of the disease.

Primary uterine lymphoma of the uterine cervix in advanced age

“…The patient was classified as stage IE according to the Ann-Arbor classification and received three cycles of postsurgical chemotherapy with R-CHOP protocol. She remains under follow-up and is disease-free.Suspicion of cervical malignancy with respect to radiological findings in our case seems to be in accordance with past studies concerning the benefits of preoperative imaging studies in the diagnosis of cervical lymphomas [3,4]. Given that the patient was in stage IE with better prognosis [5] and was free of fertility-related surgical limitations, complete surgical resection followed by three cycles of chemotherapy according to R-CHOP protocol seemed to be quite effective in this case.…”

Primary lymphomas of the female genital tract: imaging findings

“…In diffuse disease, there is uniform infiltration of the parenchyma, producing organomegaly without structural abnormalities. In the latter case, the organ contour usually is normal or slightly abnormal, even in advanced disease (2,3,6,7,10). Pelvic lymphadenopathy may also be evident (5).…”

“…On CT, lymphomas show a density similar to that of muscle or moderated hypoattenuation when compared with the surrounding parenchyma, but usually have attenuation values higher than water. On MRI, lymphomas usually exhibit low-to-intermediate signal intensity on T1-weighted imaging and moderately high signal intensity on T2-weighted imaging (2,3,6,7,10,11). Enhancement after the administration of intravenous contrast material tends to be mild and uniform.…”

“…However, in some cases, contrast-enhanced images may depict subtle heterogeneous areas that are not visible on unenhanced images. Rarely, central necrosis and hemorrhage may produce a heterogeneous appearance on unenhanced or contrast-enhanced images (2,6,7,10,12).…”

“…The differential diagnosis includes cervical carcinoma, small-cell carcinoma of the uterus, metastases, and sarcoma (5). Architectural preservation and sparing of the uterine junctional and inner layer of the cervical stroma, despite the extensive involvement of the uterine body, may suggest the diagnosis of lymphoma (6). In cases affecting the mucosa, it is difficult to differentiate lymphoma from the much more common epithelial neoplasms.…”