Primary vaginal non-Hodgkin lymphoma: gynecologic diagnosis of a hematologic malignancy

Non-Hodgkin lymphoma (NHL) predominantly affects the lymph nodes and bone marrow. Extranodal sites of NHL include the thymus, spleen, and Waldeyer ring. Very rarely NHL affects the gynecologic tract (<0.5%), and secondary spread is more common than primary involvement.

We report a case of primary NHL of the vagina diagnosed in a young woman who presented with a painless vaginal mass. Although the initial clinical diagnosis was that of an inflamed Gartner duct, atypical presentation of the mass prompted further imaging, such as pelvic ultrasonographic imaging and magnetic resonance imaging. The latter showed presence of similar masses in the posterior cervix and vagina, and after a multidisciplinary team discussion, biopsy of the mass showed primary vaginal NHL. Subsequently, we referred her to hematologists who commenced chemotherapy. Only 57 cases of primary vaginal NHL have been reported in the literature, and our case elucidates the workup of atypical vaginal masses to facilitate a diagnosis and appropriate management.

NHL of the female genital tract is uncommon. Early diagnosis translates to better survival for these women because extranodal NHLs bear a worse prognosis when compared with that of nodal lymphomas mainly owing to delay in diagnosis.