Secondary Postpartum Haemorrhage: A Rare Presentation of Secondary Uterine Mantle Cell Lymphoma
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CASE REPORT
Secondary Postpartum Haemorrhage: A Rare Presentation of Secondary Uterine Mantle Cell Lymphoma Sunesh Kumar1 • Seema Singhal1 • Aarthi S. Jayraj1 Lalit Kumar3
•
Saumyaranjan Mallick2 • Kanwalpreet Kaur2
•
Received: 28 June 2020 / Revised: 14 July 2020 / Accepted: 25 July 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Purpose Postpartum haemorrhage (PPH) is rarely the initial presentation of a disseminated non-Hodgkin lymphoma (NHL). Herein, we describe the very first case of a uterine mantle cell lymphoma (MCL) presenting with PPH. Case report A 30-year-old P1L1 female patient presented with secondary PPH following an emergency caesarean section. Ultrasonogram revealed a hypo-echoic mass in the uterine cavity, histopathological examination of which revealed MCL. Metastatic evaluation of the patient showed a widespread disease with skeletal and lymph node involvement. She was staged Ann Arbor IV NHL with International Prognostic Index (IPI) of 2/5. Results Despite chemoradiation, she succumbed to leptomeningeal spread and expired 5 months from diagnosis. Conclusion The involvement of female genital organs by malignant lymphomas is a rare but possible scenario with perilous outcomes. The unusual clinical presentations necessitate a high degree of suspicion with prompt pathological confirmation and individualised therapy. Keywords Lymphoma Mantle cell lymphoma Non-Hodgkin lymphoma Postpartum haemorrhage Secondary uterine lymphoma
Introduction Non-Hodgkin lymphoma (NHL) is the eleventh most common cancer worldwide, with an estimated age-standardised incidence rate of around 5.7 cases per 100,000 persons [1]. Mantle cell lymphoma (MCL) is an infrequent type of B cell NHL, accounting for 3–10% of all NHLs, affecting men and women in their sixth decade, with a high male predominance, an aggressive course and poor response to chemotherapy [2, 3]. They usually present with lymphadenopathy, fever, night sweats and weight loss. The involvement of the female genital tract by NHLs may
either be primary or secondary as a part of systemic disease. Secondary lymphomas of the genital tract have been reported variably in 7% to 30% of NHL cases, but only 1 in 500 cases will present with symptomatology pertaining to the female genital tract [4]. We present a case of secondary uterine NHL, who presented in her postpartum period with vaginal bleeding. This is the first case of mantle cell histology being reported in the female genital tract. Despite the expeditious diagnosis and institution of chemotherapy, the patient expired which reflects the poor prognosis inherent to the histological subtype and secondary genital involvement of NHLs.
& Aarthi S. Jayraj [email protected]
Case Report
1
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi 110029, India
2
Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
3
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India
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