Lymphoma of the uterine cervix

Lymphoma of the uterine cervix is generally uncommon and when it does occur tends to present as cervical involvement with added background multi-organ disease rather than isolated primary cervical lymphoma ¹. It is often considered part of the spectrum of uterine lymphoma.

Epidemiology

In the western world, cervical lymphoma is thought to account for 0.008% of primary cervical tumours and 1-2% of extranodal lymphoma ^2,3. It is, however, the most common site of lymphoma (primary or secondary) in the female genital tract.

While the age at presentation ranges widely can from 20-80 years, the median age is closer to 40-60 years ¹.

Clinical presentation

Common symptoms include vaginal bleeding, perineal discomfort and/or vaginal discharge. Patients may also present with an asymptomatic pelvic mass.

Pathology

Cervical cytology is often normal as these tumours arise from the cervical stroma, and the squamous epithelial lining is preserved initially. A deep cervical biopsy is essential for diagnosis.

Radiographic features

General

Diffuse uterine enlargement is the most common appearance. Less commonly, there may be a polypoidal or multinodular mass or a submucosal mass mimicking leiomyoma. In patients with multiorgan disease, the pattern of change may be typical of lymphoma, allowing a confident pre-biopsy diagnosis.

CT

Considered non-specific on CT and can have similar findings to other pelvic malignancies ⁶. CT may have a place in assessing the extent of disease within the abdomen, pelvis and beyond.

MRI

As with uterine lymphoma in general MR imaging features non-specific and can at times closely resemble that of adenocarcinoma of the cervix.

Lesions can be large while signal within the tumour is thought to be relatively homogeneous.

It has been reported that cervical lymphoma is best defined on T2 weighted images or contrast-enhanced T1 weighted images.

Signal characteristics include:

• T1: generally tends to be hypointense ²
• T2: generally tends to be hyperintense ²

• DWI: restricted diffusion (hyper(hyperintense signal on all b values and hypointense on the ADC map) ⁷ 

MR imaging findings of a preserved cervical epithelium in the presence of extensive involvement of the cervical stroma may also be a suggestive feature ².

Differential diagnosis

General imaging differential diagnosis of a cervical mass includes:

• leiomyoma of the uterine cervix: leiomyoma is smooth, exophytic, round and hypo vascularhypovascular, whereas lymphoma is expansile, lobulated and more vascular ⁸.
• carcinoma of the cervix: it shows mucosal distortion, parametrial invasion, and heterogeneous enhancement (endometrial and cervical epithelium is preserved in lymphoma of the cervix). It is slow growing, as compared to the lymphoma which is rapidly growing ⁸.

Treatment and prognosis 

Cervical lymphoma is usually treated with chemotherapy alone or in combination with irradiation or surgery. Prognosis generally tends to be favourable (especially compared with other cervical malignancies).