Lymphoma-Like Lesions of the Lower Female Genital Tract: Morphology, Immunophenotype and Molecular Features
J Turbiner, JA Ferry, NL Harris, RH Young, LR Zukerberg. Massachusetts General Hospital, Boston
Background: Lymphoma-like lesions (LLL) of the lower female genital tract were originally described by two of us in 1985. LLL are uncommon. They mainly affect women in their reproductive years. The microscopic features of these lesions differed from those of gynecologic lymphomas by having frequent surface erosion, polymorphous composition, intralesional acute inflammatory cells and plasma cells, and absence of a large mass, deep invasion or prominent sclerosis. All lesions studied by immunohistochemistry had polyclonal plasma cells. Follow-up of 6 months to 12 years was uneventful. With the advent of widespread molecular genetic testing, we have encountered cases with morphologic and immunophenotypic features of lymphoma-like lesions, but with evidence of clonal rearrangement of immunoglobulin heavy chain (IGH) genes. We examined the clinicopathologic features and outcome of these cases.
Design: LLL of the cervix (6 cases) and endometrium (2 cases) were retrieved from the consultation files of two of us. Hematoxylin and eosin-stained slides and immunohistochemical (IHC) studies for B and T-cell markers and immunoglobulin light chains were reviewed. The status of the IGH gene was analyzed with polymerase chain reaction (PCR) in 3 cases and is pending in the others. Clinical information was obtained from the referring physicians.
Results: Patients ranged in age from 18 to 54 (median 30) years. Six had abnormal PAP smears and 2 presented with vaginal bleeding. All lesions contained a dense, polymorphous inflammatory infiltrate, commonly associated with mucosal erosion. IHC showed a mixture of B and T cells without immunoglobulin light chain restriction. Three cases (all cervical) had a clonal IGH gene rearrangement by PCR. Two of the 3 patients had a coexisting high-grade squamous dysplasia and history of sexually transmitted disease. Staging studies in all 3 cases showed no clinical evidence of lymphoma. All 3 patients are alive and well after a follow-up of 1-13 months, with no clinical evidence of lymphoma.
Conclusions: We describe 8 patients with LLL of the lower female genital tract, 3 with clonal IGH gene rearrangement. The clinical and pathologic features of these cases suggest that a clonal IGH rearrangement in this setting is not sufficient for a diagnosis of lymphoma. Careful correlation of clinical, histologic, immunophenotypic and genetic features is required in these cases to avoid inappropriate treatment.
Monday, March 9, 2009 1:00 PM
Poster Session II # 129, Monday Afternoon