a 62-year - old woman experienced lower abdominal pain and vaginal bleeding lasting for 20 days . her ca15 - 3 level was 15.6 u / ml , a - fp was 1.9 ng / ml , and cea was 0.6 ng / ml . physical examination revealed marked enlargement of the uterus , though a smear test proved negative . sagittal mr images of the pelvis showed diffuse enlargement of the uterus and cervix , both of which exhibited homogeneous intermediate signal intensity on t1-weighted image ( tr [ msec ] / te [ msec ] : 700/20 ) and t2-weighted image ( tr / te : 2000/90 ) and contained an area of focal high - signal intensity , as revealed by both these modalities . diffuse anterior vaginal wall involvement was also noted , and neither the junctional zone nor normal cervical stroma were preserved ( figs . gadolinium - enhanced mr images showed relatively uniform homogeneous enhancement of the uterus , but no endometrial enhancement ( fig . needle biopsy of the vagina indicated the presence of a benign fibromuscular tumor , and trans - abdominal hysterectomy and bilateral salpingo - oophorectomy were performed . a gross specimen showed extensive necrosis of the uterus , and microscopic examination of the mass demonstrated diffuse infiltration of the myometrium , endometrium and endocervix , as well as the parametrium , vagina and adnexa , by atypical high - grade lymphoblastic lymphoma cells . high - grade lymphoblastic lymphoma of the uterus with bone marrow invasion ( ann arbor stage iv ) was diagnosed . compared with lymphoma of the ovary , malignant lymphoma of the uterus and cervix occurs in patients of very different ages , the median - particularly if the prognosis is relatively good - being the fourth decade . for prediction of a patient s survival , the stage already reached by the disease is the most important factor ( 1 , 2 ) . even in patients with extensive local disease , figo stage ii and iii , the prognosis is good if treatment with radiation therapy and/or chemotherapy is undertaken ( 1 , 2 , 6 ) . evaluation of the extent of the disease by imaging studies , especially the matter of whether or not the lesion involves adjacent organs such as the vagina , urethra and bladder , is important in deciding the method of treatment . for definitive diagnosis of the disease , large incisional or excisional biopsy uterine and cervical lymphoma showed variable features , from diffuse enlargement of the uterus to localized masses . according to a clinicopathologic analysis of 27 cases of gynecologic lymphoma by harris and scully ( 2 ) , 44% of these showed diffuse enlargement without mucosal abnormality and 41% showed variable mass - like findings such as multinodular mass , endocervical polyp and submucosal mass . in two cases , lymphoma of the vagina however , always produces ill - defined wall thickening or indentation ( 2 ) . lymphoma can mimic cervical or endometrial carcinoma or degeneratig myoma , manifesting on t2-weighted images as a mass with increased signal intensity . unlike degenerative myoma and cervical or endometrial carcinoma , gynecologic lymphoma is not sharply demarcated and shows moderate and uniform enhancement ( 3 - 5 ) . due to the fact that the condition is infiltrative , without causing stromal reaction , architectural preservation and an intact endometrium and/or junctional zone have been reported to be characteristic features of lymphoma ( 4,6,7 ) . in older , postmenopausal women , the endometrium and myometrium are infiltrated by poorly differentiated lymphoid cells and this causes endometrial destruction and an indistinct junctional zone . architectural effacement of extranodal tissue , which can usually be appreciated grossly , provides additional support for the histologic diagnosis of lymphoma ( 8) . tumoral necrosis of lymphoma is not frequent but can occur when the mass is large enough . loss of endometrial enhancement and poor differentation between the endometrium and myometrium correlated closely with the microscopic findings , which demonstrated diffuse infiltration of the endometrium and myometrium by high - grade lymphoblastic lymphoma , with a blurred margin between the two layers . in conlusion , we believe that a diagnosis of lymphoma should be considered when a markedly enlarged uterus a ) loses its normal uterine zonal architecture , b ) shows low to intermediate signal intensity on both t1- and t2-weighted images , or c ) shows poor and inhomogeneous enhancement even if areas of necrosis and endometrial disruption are present .
primary lymphoma of the uterus is a rare disease , the reported characteristic mr imaging findings being homogeneous intermediate signal intensity of the indistinct mass on t1- and t2-weighted images , and the preservation of endometrial lining and uterine architecture . 
 we report a case of primary uterine lymphoma which showed tumoral necrosis , endometrial disruption and diffuse anterior vaginal wall involvement .