Lymphoma of the cervix invading the uterine body with distant lymphadenopathy: MRI and FDG-PET/CT findings

Primary cervical lymphoma is a rare extranodal manifestation of non-Hodgkin lymphoma and may clinically and radiographically mimic primary cervical carcinoma. Involvement of the uterine body is even more uncommon and may further complicate diagnosis. We report the case of an 89-year-old woman who presented with heavy vaginal bleeding and was found to have diffuse large B-cell lymphoma (DLBCL) of the cervix with direct invasion into the uterine body and hypermetabolic pelvic, mediastinal, and supraclavicular lymphadenopathy. Multimodality imaging, including computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT), demonstrated a markedly enlarged, hypermetabolic cervical mass with disruption of the normal three-zone cervical anatomy, preservation of the endocervical canal and smooth ectocervical contour, and marked restricted diffusion–features suggestive of cervical lymphoma rather than carcinoma. The patient was treated with palliative pelvic radiation for hemostasis followed by R-mini-CHOP chemotherapy (a dose-reduced regimen consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) due to advanced age and frailty, resulting in a marked anatomic and metabolic response. This case highlights key MRI features that help differentiate cervical lymphoma from carcinoma and underscores the importance of tissue diagnosis to guide appropriate systemic therapy. Distinguishing cervical lymphoma from cervical carcinoma is clinically important, as treatment approaches differ substantially; cervical carcinoma is often managed surgically in early stages, whereas cervical lymphoma is treated primarily with systemic chemotherapy due to its inherently systemic nature.