Aggressive primary uterine non-Hodgkin's lymphoma presenting as acute kidney injury: a case report

Primary malignant lymphoma of the cervix is an extremely rare condition, accounting for only 0.008% of all cervical tumors and 2% of female extranodal lymphomas. The most common histological subtype is diffuse large B-cell lymphoma. This malignancy is often asymptomatic in its early stages, but advanced cases may include systemic symptoms, pelvic discomfort, and vaginal bleeding. Diagnosis is challenging due to its nonspecific clinical presentation and similarity to other gynecological conditions. Imaging and immunohistochemistry play essential roles in diagnosis and staging. Treatment typically involves chemotherapy, with the standard CHOP regimen for Non-Hodgkin's lymphoma being the main treatment in most cases. To the best of our knowledge, this is the first case in the literature to describe acute kidney injury associated with the already rare entity of primary female genital tract lymphoma.

A 66-year-old multiparous woman presented with severe headache, nausea, vomiting, and dizziness lasting three days, alongside systemic symptoms such as weight loss, lethargy, and night sweats. Imaging indicated bilateral hydronephrosis, ascites, and an enlarged uterus with a suspected tumor. Biopsy confirmed diffuse large B-cell lymphoma with immunohistochemical positivity for CD20 and negative CD3. The patient was classified as stage IV according to the Ann Arbor system. Initial treatment included diuretics, hemodialysis, and chemotherapy with a dose-reduced CHOP regimen due to atrial fibrillation and reduced cardiac ejection fraction. Despite initial improvements, the patient developed tumor lysis syndrome and meningeal infiltration. Her condition deteriorated after the second chemotherapy cycle, culminating in neutropenic fever, massive hemorrhage, and ultimately death.

Our case highlights the diverse manifestations of the disease, including acute kidney injury secondary to bilateral hydronephrosis, a previously unreported complication. Early recognition is essential for optimal management. While chemotherapy remains the mainstay of treatment, the lack of standardized protocols underscores the need for further research. This case emphasizes the unpredictable nature of primary female genital tract lymphomas and their potential to cause systemic complications.