Citation: BJOG: An International Journal of Obstetrics and Gynaecology. 2012, 119, 82
Author: Myagerimath R.; Azhar L.; Mwenechanya S.; Gul N.
Abstract: Introduction: Non-Hodgkin lymphoma (NHL) is rare and infrequently diagnosed in the puerperium. It can present as primary lymph node or extra-nodal disease. Non specific symptoms of this condition can cause a diagnostic dilemma leading to delay in initiation of treatment. We are reporting a case of NHL during peurperium with no similar case reports in the literature. Case Report: A 29 year old nulliparous woman had an emergency caeserean section for fetal distress. The postoperative recovery was uneventful. She presented 5 weeks later feeling generally unwell with night sweats, abdominal pain and a palpable tender abdominal mass in the left para umbilical region measuring 10- 12 cm. Ultrasound revealed 14 x 7 x 12 cm mass anterior to the aorta suggestive of para aortic lymphadenopathy. Subsequent CT scan showed abdominal lymphadenopathy with large nodules anterior to aorta extending into the left flank. The appearance was consistent with lymphoma. Laparoscopic biopsy and histology confirmed diffuse large B cell lymphoma.
Staging bone marrow trephine immunochemistry showed marrow involvement consistent with stage IV disease. She received chemotherapy to which there was good response. Discusssion: Diffuse large B-cell lymphoma are fast growing aggressive tumours but with appropriate diagnosis and prompt treatment, they respond well. Five year survival for treated patients is 30%. NHL in a young woman is a management dilemma regarding ovarian preservation and chemoradiation. But in our case since she had completed her
family we did not consider other fertility preserving techniques. Conclusion: Although abdominal masses are not uncommon findings in the puerperium, NHL should be considered in the differential diagnosis.
