- Email: [email protected]
Bartholin's gland hyperplasia in a postmenopausal woman
adverse clinical event in the sensitized subject. However, obtaining pre-treatment antibody titers is not warranted, as the rate of adverse clinical events due to delayed hypersensitivity reactions appears low.
6. DeLustro F, Condell RA, Nguyen MA, McPherson JM. A comparative study of the biologic and immunologic response to medical devices derived from dermal collagen. J Biomed Mater Res 1986;20:
References
Address reprint requests to: Michael Heif, MD Section of Urogynecology and Reconsfrucfive Pelvic Department of Obstetrics and Gynecology University of Louisville, Health Science Center 530 South Jackson Street 3rd Floor ACB Louisville. KY 40202
1. McClelland M, DeLustro F. Evaluation of antibody class in response to bovine collagen treatment in patients with urinary incontinence. J Ural 1996;155:2068-73. 2. DeLustro F, Keefe J, Fong AT, Jolivette DM. The biochemistry, biology, and immunology of injectable collagrtns: Contigen”“’ Bard”’ collagen implant in treatment of urinary incontinence. I’ediatr Surg lnt 1991;6:245-51. 3. DeLustro F, Dasch J, Keefe J, Ellingsworth L. Immune responses to allogeneic and xcnogeneic implants of collagtn and collagen derivatives. Clin Orthop 1990;260:263-79. 4. Winters JC, Appell R. Periurethral injection of collagen in the treatment of intrinsic sphinctcric deficiency m the female patient. Urol Clin North Am 1995;22:673-8. 5. Moscona RR, Bergman Ii, Friedman-Birnbaum R. An unusual late reaction to Zyderm I injections: A challenge for treatment. I’last Reconstr Surg 1993;92:337-4.
BARTHOLIN'S
GLAND
WOMAN
Peter A. Argenta, MD, Karen Bell, MD, Carol Reynolds, MD, and Robert Weinstein,
Background: rare,
with
Benign only
solid tumors
six cases
reported
MD
of Bartholin’s
gland
in
language
the
English
literature since 1966. Bartholin’s gland hyperplasia been described. Case: A postmenopausal woman with painless
are
has not
bilateral
vulvar masses underwent surgical removal of one of the masses, which revealed a well-circumscribed, nonencapsulated tumor composed of mucous glands and ducts within a dense fibrous stroma, most consistent with hyperplasia of Bartholin’s gland. Conclusion: Hyperplasia
represents
a new
etiology
for the
enlarged Bartholin’s gland. Whether the hyperplastic gland forms in response to a stimulus is unclear. However, it appears to share some features with Bartholin’s gland hamartoma or adenoma. (Obstet Gynecol 1997;90:695-7. 0 1997 by The American College of Obstetricians and Gynecologists.)
VOL.
YO, NO.
4, PART
2, OCTOBER
1997
Swgcry
Copyright 0 1997 by The American College of Obstetricians Gynecologists. Published by Elsevier Science Inc.
and
Benign solid masses of Bartholin’s gland are relatively uncommon, with only six cases reported in the English literature since 1966 (MEDLINE search 1966 to present; keywords: Bartholin’s gland, hyperplasia, adenoma, case of Bartholin’s vestibular gland). We describe a gland hyperplasia, with emphasis on the clinical presentation and pathologic findings.
HYPERPLASIA
IN A POSTMENOPAUSAL
109-20.
Case A 53-year-old
white female presented with a complaint of a palpable mass in her right labia first noted during coitus 2 days earlier. She denied associated dyspareunia, unusual discharge, or dysuria and reported no changes in her sexual activity. She was in otherwise excellent health with no notable medical history, and the mass had not been appreciated on a previous examination 5 months earlier. She had had two uncomplicated vaginal deliveries and was receiving a daily estrogen and progesterone hormone replacement therapy (HIiT) regimen for 9 months for symptoms of menopause. On examination, there were bilateral masses in the lower aspects of the labia minora at the vaginal introitus, the right measuring 4 X 2 X 2 cm and the left 3 x 1 X 1 cm. Both masses were firm, smooth, and freely mobile. Attempted needle aspiration failed to confirm a cystic lesion. After ultrasound evaluation, the patient underwent right vulvar exploration. A solid, homogeneous, avascular tumor was identified in the lowto mid-labia and was removed intact. There was no cystic component to the mass, nor was there evidence of abscess formation. The tumor was felt to be a benign neoplasm, and the right vulva was repaired. Explo-
(3029.7844/97/$17.00
1’11 S(lO29-7844(Y7)0(14OY-2
695
and benign and malignant neoplasms. Unfortunately, the varied clinical presentations of these conditions may not give adequate information for definitive diagnosis, which is critical to initiating appropriate, timely therapy. ’ Benign solid masses of Bartholin’s gland are rare, but case reports have described adenomas, hamartomas, leiomyomas, a papilloma, and a mixed salivary tumor.‘-’ Adenomas result from neoplastic growth of the epithelial elements of glandular tissue. There usually is a clear demarcation between the normal parenchyma and the affected tissue. Adenomas usually are unilateral, isolated findings; however, Mandsager and Young’ describe a case of bilateral Bartholin’s gland adenomas, which showed multiple tortuous blood vessels with varying muscular thickness in a patient who complained of dyspareunia. Foushee et al5 describe several cases involving both unilateral and bilateral Bartholin’s gland enlargement due to a proliferation of glands in a disorganized arrangement but without abnormal proliferation of the cells in the ducts or acini. These lesions were believed to be the result of a hamartomatous process with a superimposed component of hyperplasia.” In over 5O’Z of the cases described, abnormal vasculature (varices and/or cavernous hemangiomas) was seen, similar to that described in the Bartholin’s adenoma. Simple hyperplasia involves growth from cellular division retaining the architecture of the normal tissue and results usually in a functional gland. Typically, glandular growth results from changes in the hormonal milieu but also may result from a more local insult such as trauma or infection. The fundamental differences between hyperplasia and hamartoma lie in the architecture and proposed etiology of the overgrown tissue. In contrast to the hamartomas described by Foushee et al,5 our case demonstrates an increase in both the glandular and stromal elements in a normal architectural pattern. The cause of the hyperplasia in this case is unclear because the patient reported no concomitant symptoms and had not changed her HRT regimen or her sexual practices. The absence of significant clinical symptoms or microscopic evidence of dysfunction (cyst formation or inflammatory response secondary to leakage of ductal fluid) supports the hypothesis that although abnormally enlarged, the hyperplastic Bartholin’s gland remains functional. Traditional treatment for the solid enlarged Bartholin’s gland in the postmenopausal patient is complete gland excision to exclude malignant neoplasms such as adenocarcinoma and squamous cell carcinoma. These slow-growing malignant tumors present as firm, nontender, immobile masses but often go undiagnosed infection,
Figure 1. A lobule composed of mucous glands draining duct embedded within a fibrous stroma (Hematoxylin magnification X 100).
into a central and rosin,
ration of the left labia was not attempted. The patient had an uncomplicated postoperative course. At a 4-week check-up, the right labia was well healed without evidence of recurrence, and the left mass was unchanged in size. The patient was seen subsequently at 6 months and 1 year, with no appreciable change in the size of the remaining gland. Preoperative ultrasound examination of the right mass revealed a 1.6 X 2.5 X 4.1 cm lesion with internal echoes and minimal through-transmission. The left-sided lesion measured 1.9 x 2.0 x 3.3 cm and was similar in echo density. Central blood flow was recorded in each lesion. The radiologic findings were believed to be most consistent with bilaterally enlarged lymph nodes, although other solid tumors and even cystic lesions filled with nonsimple fluid such as blood or proteinaceous debris could not be ruled out definitively The resected tumor measured 4 X 3 X 1.5 cm. It was tan-pink in color and had a smooth contour without clear encapsulation. The mass was composed of dense fibrous tissue in a whorled configuration; no cysts were identified. The appearance was not consistent with a vascular lesion or lymph node. Microscopic examination revealed a well-circumscribed, nonencapsulated mass composed of mucous glands and ducts within a dense fibrous stroma (Figure 1). The glands were arranged in lobules, each containing a central duct similar to normal Bartholin’s glands. The individual lobules were surrounded by dense collagen and fibrosis. The glands were lined by columnar mucin-containing epithelium without cytologic atypia. Focally, the ducts showed squamous metaplasia. Rare dilated ducts containing mutinous material also were seen. The appearance of the lesion was uniform in all sections. There was no evidence of cyst formation, dilated vascular channels, or inflammatory infiltration within the lesion. The surrounding soft tissue appeared normal.
Comment The gland
differential is limited.
diagnosis Etiologies
for
an
enlarged
Bartholin’s
include
ductal
obstruction,
until
there
has
been
local
invasion
and/or
metastasis.7
Histologically, these tumors are easily distinguished from benign processes by the presence of cellular atypia with architectural disorganization and invasive growth. Given the low incidence of Bartholin’s gland carcinoma in the premenopausal woman, however, it appears prudent to follow the recommendations of Visco and Del Priore* of incision with drainage and biopsy as the initial step in the evaluation of enlarged Bartholin’s glands. Follow-up data from all reports of benign solid tumors of Bartholin’s gland have demonstrated an excellent prognosis.2-4,6 Our patient likewise has shown no evidence of recurrence after 12 months. The remaining gland continues to be palpable but asymptomatic and has shown no change in size.
4. Ordonez NG, Manning JT, Luna MA. Mixed tumor of the vulva: A report of two cases probably arising in Bartholin’s gland. Cancer 1981;48:181-6. 5. Foushee JHS, Reeves WJ, McCool JA. Benign masses of the Bartholin’s gland. Obstet Gynecol 1968;31:695-701. 6. Morehead RF’. Human pathology. New York: McGraw-Hill, lY65. 7. Hacker NF, Eifel P, McGuire W, Wilkinson EJ. Vulva. In: Hoskins WJ, Perez CA, Young RC, eds. Princtples and practice of gynecologic oncology. 1st ed. Philadelphia:JB Lippincott, 1992:544. 8. Visco AG, Del Priore G. Postmenopausal Bartholin’s gland enlargement: A hospital-based cancer risk assessment. Obstet Gynecol 1996;87:286-90.
Address reprint requests to:
References
Robert Weinstein, MD Department of Obstetrics Ddles Pazdion, Zst Floor Hospifd of the Lhimmity Philadclphin, PA 29230
1. Weinstein RS. Enlarged Bartholin’s gland. In: Celso-Rambn G, Mikuta JJ, Rosenblum NG, eds. Current therapy in surgical gynecology. 1st ed. Philadelphia:BC Decker, 1987:158-62. 2. Mandsager NT, Young TW. Pain during sexual response due to bilateral Bartholin’s gland adenomas. A case report. J Reprod Med 1992;37:983-5. 3. Enghardt MH, Valente PT, Day DH. Papilloma of Bartholin’s gland duct cyst: First report of a case. Int J Gynecol Path 1993;12:86-92.
Copyright 0 1997 by The American College of Obstetricians Gynecologists. Published by Elsevier Science Inc.
NON-HODGKIN
LYMPHOMA
ENDOMETRIUM
IN
OF
THE
HUMAN
IMMUNODEFICIENCY
VIRUS
E. Jason Gates, MD, Conception Dim-Arrastia, MD, Tkerese DiMuio, MD, und Mitchell A. Muimun, MD
Background: Non-Hodgkin lymphoma has become a common malignancy in patients infected with the human immunodeficiency virus (HIV), being classified as an acquired immunodeficiency syndrome-defining malignancy. The female genital tract is involved usually with non-Hodgkin lymphoma as part of disseminated disease. It is extremely rare for this tumor to originate in the female reproductive tract, especially in the endometrium. Case: An HIV-positive woman underwent a total abdom-
90, NO.
G~WJIO~J
of Pr~~f~syhfr~in
and
inal hysterectomy and bilateral salpingo-oophorectomy for intractable menometorrhagia and resultant anemia thought to be secondary to uterine leiomyoma. The histologic diagnosis was high-grade, immunoblastic, non-Hodgkin lymphoma with plasmacytoid features originating in the endometrium.
Conclusion: This unusual presentation obligates the clini-
INFECTION
VOL.
ard
4, PART
2, OCTOBER
1997
cian to include non-Hodgkin lymphoma in the differential diagnosis when evaluating HIV-positive patients with abnormal uterine bleeding that cannot be explained after thorough evaluation. (Obstet Gynecol 1997;90:697-9. 0 1997 by The American College of Obstetricians and Gynecologists.)
Patients infected with the human immunodeficiency virus (HIV) are classified as having acquired immunodeficiency syndrome (AIDS) in the presence of specific malignancies. These AIDS-defining malignancies include Kaposi sarcoma, primary central nervous system lymphoma, non-Hodgkin lymphoma, and, as of 1993, cervical cancer.’ Approximately 5-10% of AIDS patients will develop non-Hodgkin lymphoma during the course of their disease.’ These tumors have a propensity to be high grade and to present in advanced stage, often in extranodal sites such as the central nervous system and bone marrow. The female genital tract is involved
oO29-7844/97/$17.00 PI1 SOO29-7844(Y7)00091-4
697
6. DeLustro F, Condell RA, Nguyen MA, McPherson JM. A comparative study of the biologic and immunologic response to medical devices derived from dermal collagen. J Biomed Mater Res 1986;20:
References
Address reprint requests to: Michael Heif, MD Section of Urogynecology and Reconsfrucfive Pelvic Department of Obstetrics and Gynecology University of Louisville, Health Science Center 530 South Jackson Street 3rd Floor ACB Louisville. KY 40202
1. McClelland M, DeLustro F. Evaluation of antibody class in response to bovine collagen treatment in patients with urinary incontinence. J Ural 1996;155:2068-73. 2. DeLustro F, Keefe J, Fong AT, Jolivette DM. The biochemistry, biology, and immunology of injectable collagrtns: Contigen”“’ Bard”’ collagen implant in treatment of urinary incontinence. I’ediatr Surg lnt 1991;6:245-51. 3. DeLustro F, Dasch J, Keefe J, Ellingsworth L. Immune responses to allogeneic and xcnogeneic implants of collagtn and collagen derivatives. Clin Orthop 1990;260:263-79. 4. Winters JC, Appell R. Periurethral injection of collagen in the treatment of intrinsic sphinctcric deficiency m the female patient. Urol Clin North Am 1995;22:673-8. 5. Moscona RR, Bergman Ii, Friedman-Birnbaum R. An unusual late reaction to Zyderm I injections: A challenge for treatment. I’last Reconstr Surg 1993;92:337-4.
BARTHOLIN'S
GLAND
WOMAN
Peter A. Argenta, MD, Karen Bell, MD, Carol Reynolds, MD, and Robert Weinstein,
Background: rare,
with
Benign only
solid tumors
six cases
reported
MD
of Bartholin’s
gland
in
language
the
English
literature since 1966. Bartholin’s gland hyperplasia been described. Case: A postmenopausal woman with painless
are
has not
bilateral
vulvar masses underwent surgical removal of one of the masses, which revealed a well-circumscribed, nonencapsulated tumor composed of mucous glands and ducts within a dense fibrous stroma, most consistent with hyperplasia of Bartholin’s gland. Conclusion: Hyperplasia
represents
a new
etiology
for the
enlarged Bartholin’s gland. Whether the hyperplastic gland forms in response to a stimulus is unclear. However, it appears to share some features with Bartholin’s gland hamartoma or adenoma. (Obstet Gynecol 1997;90:695-7. 0 1997 by The American College of Obstetricians and Gynecologists.)
VOL.
YO, NO.
4, PART
2, OCTOBER
1997
Swgcry
Copyright 0 1997 by The American College of Obstetricians Gynecologists. Published by Elsevier Science Inc.
and
Benign solid masses of Bartholin’s gland are relatively uncommon, with only six cases reported in the English literature since 1966 (MEDLINE search 1966 to present; keywords: Bartholin’s gland, hyperplasia, adenoma, case of Bartholin’s vestibular gland). We describe a gland hyperplasia, with emphasis on the clinical presentation and pathologic findings.
HYPERPLASIA
IN A POSTMENOPAUSAL
109-20.
Case A 53-year-old
white female presented with a complaint of a palpable mass in her right labia first noted during coitus 2 days earlier. She denied associated dyspareunia, unusual discharge, or dysuria and reported no changes in her sexual activity. She was in otherwise excellent health with no notable medical history, and the mass had not been appreciated on a previous examination 5 months earlier. She had had two uncomplicated vaginal deliveries and was receiving a daily estrogen and progesterone hormone replacement therapy (HIiT) regimen for 9 months for symptoms of menopause. On examination, there were bilateral masses in the lower aspects of the labia minora at the vaginal introitus, the right measuring 4 X 2 X 2 cm and the left 3 x 1 X 1 cm. Both masses were firm, smooth, and freely mobile. Attempted needle aspiration failed to confirm a cystic lesion. After ultrasound evaluation, the patient underwent right vulvar exploration. A solid, homogeneous, avascular tumor was identified in the lowto mid-labia and was removed intact. There was no cystic component to the mass, nor was there evidence of abscess formation. The tumor was felt to be a benign neoplasm, and the right vulva was repaired. Explo-
(3029.7844/97/$17.00
1’11 S(lO29-7844(Y7)0(14OY-2
695
and benign and malignant neoplasms. Unfortunately, the varied clinical presentations of these conditions may not give adequate information for definitive diagnosis, which is critical to initiating appropriate, timely therapy. ’ Benign solid masses of Bartholin’s gland are rare, but case reports have described adenomas, hamartomas, leiomyomas, a papilloma, and a mixed salivary tumor.‘-’ Adenomas result from neoplastic growth of the epithelial elements of glandular tissue. There usually is a clear demarcation between the normal parenchyma and the affected tissue. Adenomas usually are unilateral, isolated findings; however, Mandsager and Young’ describe a case of bilateral Bartholin’s gland adenomas, which showed multiple tortuous blood vessels with varying muscular thickness in a patient who complained of dyspareunia. Foushee et al5 describe several cases involving both unilateral and bilateral Bartholin’s gland enlargement due to a proliferation of glands in a disorganized arrangement but without abnormal proliferation of the cells in the ducts or acini. These lesions were believed to be the result of a hamartomatous process with a superimposed component of hyperplasia.” In over 5O’Z of the cases described, abnormal vasculature (varices and/or cavernous hemangiomas) was seen, similar to that described in the Bartholin’s adenoma. Simple hyperplasia involves growth from cellular division retaining the architecture of the normal tissue and results usually in a functional gland. Typically, glandular growth results from changes in the hormonal milieu but also may result from a more local insult such as trauma or infection. The fundamental differences between hyperplasia and hamartoma lie in the architecture and proposed etiology of the overgrown tissue. In contrast to the hamartomas described by Foushee et al,5 our case demonstrates an increase in both the glandular and stromal elements in a normal architectural pattern. The cause of the hyperplasia in this case is unclear because the patient reported no concomitant symptoms and had not changed her HRT regimen or her sexual practices. The absence of significant clinical symptoms or microscopic evidence of dysfunction (cyst formation or inflammatory response secondary to leakage of ductal fluid) supports the hypothesis that although abnormally enlarged, the hyperplastic Bartholin’s gland remains functional. Traditional treatment for the solid enlarged Bartholin’s gland in the postmenopausal patient is complete gland excision to exclude malignant neoplasms such as adenocarcinoma and squamous cell carcinoma. These slow-growing malignant tumors present as firm, nontender, immobile masses but often go undiagnosed infection,
Figure 1. A lobule composed of mucous glands draining duct embedded within a fibrous stroma (Hematoxylin magnification X 100).
into a central and rosin,
ration of the left labia was not attempted. The patient had an uncomplicated postoperative course. At a 4-week check-up, the right labia was well healed without evidence of recurrence, and the left mass was unchanged in size. The patient was seen subsequently at 6 months and 1 year, with no appreciable change in the size of the remaining gland. Preoperative ultrasound examination of the right mass revealed a 1.6 X 2.5 X 4.1 cm lesion with internal echoes and minimal through-transmission. The left-sided lesion measured 1.9 x 2.0 x 3.3 cm and was similar in echo density. Central blood flow was recorded in each lesion. The radiologic findings were believed to be most consistent with bilaterally enlarged lymph nodes, although other solid tumors and even cystic lesions filled with nonsimple fluid such as blood or proteinaceous debris could not be ruled out definitively The resected tumor measured 4 X 3 X 1.5 cm. It was tan-pink in color and had a smooth contour without clear encapsulation. The mass was composed of dense fibrous tissue in a whorled configuration; no cysts were identified. The appearance was not consistent with a vascular lesion or lymph node. Microscopic examination revealed a well-circumscribed, nonencapsulated mass composed of mucous glands and ducts within a dense fibrous stroma (Figure 1). The glands were arranged in lobules, each containing a central duct similar to normal Bartholin’s glands. The individual lobules were surrounded by dense collagen and fibrosis. The glands were lined by columnar mucin-containing epithelium without cytologic atypia. Focally, the ducts showed squamous metaplasia. Rare dilated ducts containing mutinous material also were seen. The appearance of the lesion was uniform in all sections. There was no evidence of cyst formation, dilated vascular channels, or inflammatory infiltration within the lesion. The surrounding soft tissue appeared normal.
Comment The gland
differential is limited.
diagnosis Etiologies
for
an
enlarged
Bartholin’s
include
ductal
obstruction,
until
there
has
been
local
invasion
and/or
metastasis.7
Histologically, these tumors are easily distinguished from benign processes by the presence of cellular atypia with architectural disorganization and invasive growth. Given the low incidence of Bartholin’s gland carcinoma in the premenopausal woman, however, it appears prudent to follow the recommendations of Visco and Del Priore* of incision with drainage and biopsy as the initial step in the evaluation of enlarged Bartholin’s glands. Follow-up data from all reports of benign solid tumors of Bartholin’s gland have demonstrated an excellent prognosis.2-4,6 Our patient likewise has shown no evidence of recurrence after 12 months. The remaining gland continues to be palpable but asymptomatic and has shown no change in size.
4. Ordonez NG, Manning JT, Luna MA. Mixed tumor of the vulva: A report of two cases probably arising in Bartholin’s gland. Cancer 1981;48:181-6. 5. Foushee JHS, Reeves WJ, McCool JA. Benign masses of the Bartholin’s gland. Obstet Gynecol 1968;31:695-701. 6. Morehead RF’. Human pathology. New York: McGraw-Hill, lY65. 7. Hacker NF, Eifel P, McGuire W, Wilkinson EJ. Vulva. In: Hoskins WJ, Perez CA, Young RC, eds. Princtples and practice of gynecologic oncology. 1st ed. Philadelphia:JB Lippincott, 1992:544. 8. Visco AG, Del Priore G. Postmenopausal Bartholin’s gland enlargement: A hospital-based cancer risk assessment. Obstet Gynecol 1996;87:286-90.
Address reprint requests to:
References
Robert Weinstein, MD Department of Obstetrics Ddles Pazdion, Zst Floor Hospifd of the Lhimmity Philadclphin, PA 29230
1. Weinstein RS. Enlarged Bartholin’s gland. In: Celso-Rambn G, Mikuta JJ, Rosenblum NG, eds. Current therapy in surgical gynecology. 1st ed. Philadelphia:BC Decker, 1987:158-62. 2. Mandsager NT, Young TW. Pain during sexual response due to bilateral Bartholin’s gland adenomas. A case report. J Reprod Med 1992;37:983-5. 3. Enghardt MH, Valente PT, Day DH. Papilloma of Bartholin’s gland duct cyst: First report of a case. Int J Gynecol Path 1993;12:86-92.
Copyright 0 1997 by The American College of Obstetricians Gynecologists. Published by Elsevier Science Inc.
NON-HODGKIN
LYMPHOMA
ENDOMETRIUM
IN
OF
THE
HUMAN
IMMUNODEFICIENCY
VIRUS
E. Jason Gates, MD, Conception Dim-Arrastia, MD, Tkerese DiMuio, MD, und Mitchell A. Muimun, MD
Background: Non-Hodgkin lymphoma has become a common malignancy in patients infected with the human immunodeficiency virus (HIV), being classified as an acquired immunodeficiency syndrome-defining malignancy. The female genital tract is involved usually with non-Hodgkin lymphoma as part of disseminated disease. It is extremely rare for this tumor to originate in the female reproductive tract, especially in the endometrium. Case: An HIV-positive woman underwent a total abdom-
90, NO.
G~WJIO~J
of Pr~~f~syhfr~in
and
inal hysterectomy and bilateral salpingo-oophorectomy for intractable menometorrhagia and resultant anemia thought to be secondary to uterine leiomyoma. The histologic diagnosis was high-grade, immunoblastic, non-Hodgkin lymphoma with plasmacytoid features originating in the endometrium.
Conclusion: This unusual presentation obligates the clini-
INFECTION
VOL.
ard
4, PART
2, OCTOBER
1997
cian to include non-Hodgkin lymphoma in the differential diagnosis when evaluating HIV-positive patients with abnormal uterine bleeding that cannot be explained after thorough evaluation. (Obstet Gynecol 1997;90:697-9. 0 1997 by The American College of Obstetricians and Gynecologists.)
Patients infected with the human immunodeficiency virus (HIV) are classified as having acquired immunodeficiency syndrome (AIDS) in the presence of specific malignancies. These AIDS-defining malignancies include Kaposi sarcoma, primary central nervous system lymphoma, non-Hodgkin lymphoma, and, as of 1993, cervical cancer.’ Approximately 5-10% of AIDS patients will develop non-Hodgkin lymphoma during the course of their disease.’ These tumors have a propensity to be high grade and to present in advanced stage, often in extranodal sites such as the central nervous system and bone marrow. The female genital tract is involved
oO29-7844/97/$17.00 PI1 SOO29-7844(Y7)00091-4
697