Diffuse Large B Cell Lymphoma Presenting as Isolated Peritoneal Lymphomatosis: A Gynecologic Case Report and Review of L

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CASE REPORT

Diffuse Large B Cell Lymphoma Presenting as Isolated Peritoneal Lymphomatosis: A Gynecologic Case Report and Review of Literature Steffi Chacko1 • Lakshmi Haridas Kamala1



Sreejith G. Nair1 • A. V. Jayasudha2

Received: 6 September 2020 / Accepted: 9 November 2020 / Published online: 24 November 2020  Association of Gynecologic Oncologists of India 2020

Abstract Background Peritoneal disease in female oncology is frequently due to peritoneal carcinomatosis. Gynaecologic presentation due to isolated peritoneal lymphomatosis (PL) is rarely reported. The pathogenesis of de-novo PL is not yet understood, as peritoneum is devoid of native lymphoid tissue. Only two such cases have been reported in the literature till date. Purpose This case adds to the present gynaecologic literature as the third case of isolated PL. Methods and Results This case report is about a 61-year-old female with isolated PL—diffuse large B cells, germinal centre subtype, with no lymph node or organ involvement. The patient succumbed to her illness within a month of initial presentation, in spite of early treatment initiation. Conclusion Isolated PL is an extremely rare and aggressive entity that portends a dismal outcome. Hence, further diagnostic and therapeutic advancement in these subgroups of poor prognostic lymphomas is warranted. Keywords Isolated peritoneal lymphomatosis  Extranodal lymphomas  Peritoneal malignancy

Introduction PL is an extremely rare entity mostly associated with nonHodgkin’s lymphoma. This refers to diffuse seeding of peritoneum and omentum by lymphomatous cells, usually secondary to continuous spread from gastrointestinal (GI) tract, intra-abdominal visceral organs and lymph nodes. GI lymphoma constitutes 5-20% of extranodal lymphomas with stomach and small intestine being the most common sites [1]. However, isolated PL is an even more rare & Lakshmi Haridas Kamala [email protected] Steffi Chacko [email protected] Sreejith G. Nair [email protected] A. V. Jayasudha [email protected] 1

Department of Medical Oncology, Regional Cancer Centre, Trivandrum, Trivandrum, Kerala 695011, India

2

Department of Pathology, Regional Cancer Centre, Trivandrum, Trivandrum, Kerala 695011, India

extranodal entity. PL is indistinguishable from peritoneal carcinomatosis (PC) but has distinct lines of management, thereby posing clinical challenge to the practising oncologists. Here we report a female with diffuse large B cell lymphoma (DLBCL) presenting as isolated PL without nodal or visceral involvement, which is third such a case in the literature to the best of our knowledge.

Presentation of a case A 61-year-old female presented with a week history of rapidly progressive abdominal distension and abdominal pain. She noticed decreased appetite, significant weight loss and fatigue over the past fortnight. She denied any vomiting, hematemesis, malena, bleeding per rectum, jaundice, fever or night sweats. She lived with two children and reported no comorbidities or addictions or prior medications or