Hodgkin lymphoma presenting as a vulvar mass in a patient with crohn disease: a case report and literature review.

OBJECTIVE: A case of Hodgkin lymphoma of the vulva and perineum is presented along with a review of the literature. MATERIALS AND METHODS: Medical chart and clinical images were reviewed. RESULTS: A 45-year-old female patient with a longstanding history of Crohn disease presented with a large vulvar and perineal mass. Physical examination revealed a mass measuring approximately 20 x 20 cm involving primarily the labia majora, the labia minora, and the clitoris as well as the perineum. Incisional biopsy of the vulvar mass revealed histologic diagnosis and immunohistochemistry typical of classic Hodgkin lymphoma. Imaging revealed involvement of multiple lymph nodes as well as the liver. The patient was designated as having stage IV disseminated Hodgkin lymphoma, and chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine was instituted. A significant reduction of the size of the vulvar mass was observed following 8 cycles of chemotherapy. CONCLUSIONS.: Lymphoma of the vulva is rare with the majority being of the non-Hodgkin lymphoma type. The most common subtypes of vulvar lymphoma reported are diffuse large B-cell lymphoma and follicular lymphoma. Perianal Hodgkin lymphoma is also very rare but has been reported in association with human immunodeficiency virus infection, Epstein-Barr virus infection, and Crohn disease. This is only the second reported case of Hodgkin lymphoma of the vulva and the second case of Hodgkin lymphoma involving the perianal area in a female patient. There is currently no evidence that Crohn disease is associated with an increased risk of Hodgkin lymphoma.

Clinical value of image-guided fine needle aspiration of retroperitoneal masses and lymph nodes in gynecologic oncology.

OBJECTIVE: Evaluation of the sensitivity and specificity of fine needle aspiration of retroperitoneal masses and lymph nodes in gynecologic oncology. METHODS: Retrospective study of 101 punctures administered to 84 patients aged 23-86 years. The method's sensitivity and specificity were evaluated by clinical follow-up. RESULTS: A satisfactory sampling was obtained in 89.1% of punctures, and a cytological diagnosis was made in 88.1%. The size of the lymph nodes punctured was less than 14 mm in 46.5%. This test has a sensitivity of 87.5%, specificity of 88.9%, positive predictive value of 98%, negative predictive value of 53.3%, and accuracy of 87.7%. Four patients presented complications: pain (2), hematoma (1), and right ureteral perforation (1). CONCLUSIONS: The fine needle aspiration technique has excellent positive predictive value and low morbidity. As a method of visualization, CT-scan, in combination with lymphography, allows the location of small lesions and the definition of their internal structures. The weak negative predictive value of fine needle aspiration might be correctible by laparoscopy-directed biopsy, and its potential is clearly ensured by the development of techniques for locating sentinel lymph nodes.