Non Hodgkins Lymphoma in the puerperium, a rare case.

1. Non Hodgkins Lymphoma in the puerperium, a rare case. Dr R Myagerimath, Dr L Azhar, Miss Nahid Gul, Miss S Mwenechanya Wirral University Teaching Hospital NHS Foundation trust UnitedKingdom Introduction Investigations Treatment • Multi Disciplinary meeting • Received 6 cycles of chemotherapy • ( R-CHOP) Rituximab, cyclophosphamide, Doxorubicin Hydrochloride, Vincristin, prednisolone to which there was good response. • Good response • Non Hodgkins Lymphoma is rare and infrequently diagnosed in the puerperium. • It has bimodal pattern with sharp increase in young age. • Can present as primary lymph node or extra-nodal disease. • Non specific symptoms of this condition can cause a diagnostic dilemma in pregnancy and puerperium leading to subsequent delay in initiation of treatment. • We are reporting a case of Non Hodgkins Lymphoma during peurperium with no similar case reports in the literature. • Ultrasound revealed 14x 7x12 cms mass anterior to the aorta suggestive of para aortic lymphadenopathy. • Haematological and biochemical markers were normal. • CT abdomen and pelvis showed massive abdominal lymphadenopathy with large nodules surrounding the aorta and a huge nodal mass 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. Diffuse large B cell Lymphoma Case Report: • 29 years old nulliparous woman low risk antenatal care. • Spontaneous labour had an emergency caeserean section for fetal distress. • The postoperative recovery uneventful . • 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 cms in size. Histology Conclusions • Although abdominal masses are not uncommon findings in the puerperium, Non Hodgkins Lymphoma should be considered in the differential diagnosis. ... Discussion • Diffuse large B-cell lymphoma are fast growing aggressive tumours • With appropriate diagnosis and prompt treatment, they respond well. • Five year survival for treated patients is 30%. • Non Hodgkins Lymphoma in a young woman is a management dilemma regarding ovarian preservation and chemoradiation. • Index case had completed her family hence other fertility preserving techniques were not considered. References Zentralbl Gynakol. 2005 Aug;127(4):248-51 Obstetrics & Gynecology, August 2011, vol./is. 118/2 Pt 2(486-9), 0029-7844;1873-233X (2011 Aug) Jcpsp, Journal of the College of Physicians & Surgeons - Pakistan, June 2006, vol./is. 16/6(424-5), 1022-386X;1022-386X (2006 Jun) Lancet Oncol. 2006 Aug;7(8):693-4 Diffuse large B cell Lymhoma