CASE 1401 Published on 10.12.2002

ECR 2002 COD #18: Diffuse large B cell extranodal vaginal lymphoma

Section

Genital (female) imaging

Case Type

Clinical Cases

Authors

Santiago Isarria, MD, Luis MartĂ­-BonmatĂ­, MD

Patient

45 years, female

Categories
No Area of Interest ; Imaging Technique CT, MR, MR
Clinical History
The patient presented with a colicky pain in the right iliac fossa of 1 month's duration. She was the mother of two children and had a tubal ligature. There were no urinary symptoms. On physical gynaecological exploration the vagina was enlarged and of petrous consistency.
Imaging Findings
The patient presented with a colicky pain in the right iliac fossa of 1 month's duration. She was the mother of two children and had a tubal ligature. There were no urinary symptoms. On physical gynaecological exploration the vagina was enlarged and of petrous consistency.

Endovaginal ultrasound showed an enlarged and heterogeneous uterus with multiple hypoechoic myomatous nodules. Contrast enhanced CT showed a myomatous uterus with hyperenhancing myomas. A large vaginal hyperenhancing mass was seen without rectal invasion. There was no lymph node enlargement. On MRI examination a large vaginal wall lesion was seen with enhancement throughout the vagina. Uterine myomas and a small quantity of free fluid was present.

After treatment, 2 months after the first MRI, a repeat MRI examination demonstrated a decrease in the size of the diffuse vaginal wall lesion.

Discussion
Primary tumours of the vagina account for 1-2% of all gynaecologic neoplasias, and 90% of them are squamous cell carcinomas. Primary lymphoma is an extremely rare neoplasm, representing less than 1% of all extranodal lymphomas. Clinical symptoms are bleeding and vaginal discharge. In most cases the tumour infiltrates and enlarges the vaginal wall without affecting the endothelium. MRI is the preferred imaging modality. CT findings are non-specific, showing a large bulky vaginal mass. On MRI this lesion is usually heterogeneous in T2-weighted images and contrast-enhanced T1-weighted images, diffusely infiltrating and enlarging the vaginal walls.
Differential Diagnosis List
Diffuse large B cell extranodal vaginal lymphoma
Final Diagnosis
Diffuse large B cell extranodal vaginal lymphoma
Case information
URL: https://www.eurorad.org/case/1401
DOI: 10.1594/EURORAD/CASE.1401
ISSN: 1563-4086