PMC5140869_01
Fluorodeoxyglucose (FDG) -positron emission tomography (PET) and PET/computed tomography (CT) fusion images. (A) A PET image showing increased FDG uptake only in the intrapelvic region. (B) Coronal and (C) axial views of PET/CT reveal the accumulation of FDG in the fundus of the uterus. L: left, R: right
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A 72-year-old Japanese female without any symptoms underwent an annual positron emission tomography (PET)-computed tomography (CT) examination for opportunistic cancer screening, and metabolically active foci with maximal standardized uptake values of six were found in the fundus and front wall of the uterus (Fig. 1).
T2-weighted fast spin-echo and dynamic gadolinium-enhanced magnetic resonance imaging (MRI). (A) Axial and (B) sagittal views of T2-weighted fast spin-echo MRI show few abnormalities in the uterine endometrium.There are few findings to indicate the presence of extra-uterine invasion (arrows). A dynamic MRI scan showing (C) early enhancing lesions in the fundic myometrium. (D) In the late phase, the lesions show relatively lower intensity than in the other area of the myometrium.These findings suggest that uterine sarcoma or malignant lymphoma are more likely than endometrial carcinoma.
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Although it revealed marked early enhancement in the uterus, few endometrial abnormalities were observed (Fig. 2).
A cytological analysis of the endometrium. (A) Papanicolaou staining shows that the cells were arranged in a predominantly single cell pattern with naked nuclei (x100). (B) The cells with cytoplasm demonstrated high nuclear to cytoplasmic ratios. Their morphology varied, and nuclear pleomorphisms, such as binucleated forms could be seen. These findings suggest that the cells were clearly malignant and that a diagnosis of endometrial carcinoma was less likely (x400).
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A cytological examination of the cervix and uterine mucosa revealed the presence of non-epithelial malignant cells (Fig. 3).
Macroscopic and histopathological examinations. (A) A macroscopic view of the uterus and the ovaries revealed their normal appearance without any evidence of tumor. (B) Hematoxylin and Eosin staining sections of the uterus (x20) and (C) a higher magnification image (x400) shows that the blood vessels were filled with lymphoma cells. (D) The tumor cells in the uterine vessels were highlighted by immunohistochemical staining for CD20 (x20). Capillaries in the right (E) and left (F) ovaries were also filled with lymphoma cells (x200).
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The pathological findings showed that the lymphoma cells were almost exclusively contained within the blood vessels, including the capillaries, without an obvious extravascular tumor mass (Fig. 4).