The vagina is a rare site for both primary non-Hodgkin's lymphoma and malak
oplakia. We report a case of concurrent diffuse large B-cell lymphoma and m
alakoplakia of the vagina in a 67-year-old woman presenting with a vaginal
discharge and a vaginal mass. The patient had two biopsy specimens reported
as showing malakoplakia only, followed by a third biopsy specimen 10 month
s later which was diagnosed as diffuse large B-cell lymphoma. Review of the
first two biopsy specimens showed areas of histiocytes with Michaelis-Gutm
an bodies merging with areas of cells with slightly larger nuclei aid more
amphophilic cytoplasm. Immunohistochemistry for the B-cell marker L-26 (CD2
0) and polymerase chain reaction analysis of the immunoglobulin heavy chain
gene were helpful in retrospectively distinguishing the population of diff
use large B-cell lymphoma from the areas of malakoplakia. The third biopsy
specimen showed sheets of large atypical lymphoid cells characteristic of a
large cell lymphoma. Malakoplakia has been described in association with a
variety of cancers, and this is only the second report of malakoplakia ass
ociated with non-Hodgkin's lymphoma. Considering the rarity of these two en
tities in the vagina, it is unlikely that the association in this case is c
oincidental, raising the possibilities of an unusual reaction to the presen
ce of lymphoma or a common pathogenesis such as underlying chronic inflamma
tion. Epstein-Barr virus DNA was detected in the second biopsy specimen, su
ggesting a possible role in the pathogenesis of this lymphoma. Copyright (C
) 1999 by W.B. Saunders Company.