Primary non-Hodgkin's lymphoma and malakoplakia of the vagina: A case report

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.