[Unrecognized malignant lymphomas simulating a primary gynecologic malignancy]

The discovery of a so far unknown lymphoma in the female genital tract is rare. According to Chorlton et al., malignant lymphoma manifests itself primarily in the ovary and uterus in 0.3% and 0.12% of cases respectively. Four personally observed cases are reported with special emphasis on the clinical and histological difficulties encountered in the diagnosis of this rare clinical picture. After analysis of data in the literature, an attempt is made to define criteria, which should lead clinicians and pathologists to consider the possibility of such an event. Women of all age groups may be affected. Malignant lymphoma occurring primarily in the uterus usually mimics infiltrative carcinoma of the cervix causing vaginal discharge and post-coital bleeding. There are no specific symptoms. The presence of an undifferentiated round-cell tumor which is difficult to classify histologically and develops rapidly should suggest the possibility of malignant lymphoma. When the primary manifestation is an ovarian tumor, the lesion is bilateral in about 55% of cases. The presence of ascites is very rarely reported. In most cases these tumors are histologically misdiagnosed primarily as granulosa cell tumors, dysgerminomas or undifferentiated carcinomas. The diffuse and poorly differentiated lymphocytic type is most frequently encountered in adults. In children, granulocytic sarcoma or so-called chloroma may be found. In the presence of bilateral ovarian tumor without ascites and displaying unclear histological features in frozen sections, the possibility of malignant lymphoma should always be considered. In such cases it is advisable to process some of the tumor tissue for special subsequent morphologic and/or immunologic investigations.