Tehran University Medical Journal

Background: Although cervical malignancy rate had grown up in recent years, primary cervical lymphoma is so rare. It must be high index of suspicious for primary cervical lymphoma diagnosis in patient with malignancy-like signs and symptoms for early detection. Primary cervical lymphoma has no standard treatment or follow-up protocol; so the management still is in doubt and based on previous case reports. In the other hand, the precise prognosis of patient is undetermined. In the present study, a case of primary cervical lymphoma is presented which was misdiagnosed at first. The patient accurate diagnosis was made at last due to multidisciplinary team working.
Case presentation: A 51-year-old woman, gravida 2, para 2, presented with complaint of abnormal vaginal bleeding and discharge, with no abnormal finding in cervical cytology and sonography, so uneventfully a diagnostic error had happened in the assessment of her. After several months and multiple different treatment, the patient referred to the Oncology Department of Obstetrics and Gynecology Center, Ghaem Hospital, Mashhad, Iran in May 2017. Re-assessment was performed by biopsy and imaging, and the final pathologic diagnosis of diffuse large B-cell non-Hodgkin's lymphomas was confirmed.
Conclusion: Primary cervical lymphoma is an uncommon malignancy; the diagnosis could be missed simply by low suspicious due to low accuracy of Pap smear and imaging in this situation. So an accurate evaluation and pelvic examination, high suspicious and close communication between clinician and pathologist are needed. By timely diagnosis of patient in early stage and appropriate approach, the prognosis could be excellent most of the time.

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL), which is the most common type of lymphoma. NHL comprises a group of clinically and biologically diverse diseases, which range from indolent to aggressive clinical courses. Despite treatment advances in the last three decades with the use of combination immunotherapy, a significant fraction of patients relapses or are refractory to these treatments. Actually, there is no standard method for detection of recurrence. The purpose of this study was to evaluate the level of this enzyme in the patients with recurrent DLBCL compared to healthy controls.
Methods: In this randomized double-blind, placebo-controlled trial, the serum level of pyruvate dehydrogenase (PDH) enzyme in total of 26 patients with DLBCL recurrence in compare with 26 healthy individuals in the Sayed Al-Shohada Hospital, Isfahan University of Medical Sciences in Iran from September 2016 to September 2018, were assessed. The clinical data including age criteria, the Eastern Cooperative Oncology Group (ECOG) score rating, total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time and international normalized ratio (PT/INR), CT-scan, serum creatinine, platelet count, the absolute number of neutrophils, and the interval until the last treatment were gathered. After obtaining informed consent, blood samples were taken. and the PDH enzyme was measured in case and control groups.
Results: Fifty-three percent of patients were male and the mean age of participants in case and control groups was 37.2±17.3 and 34.8±8.9, respectively. Subsequently, the PDH levels were measured according to the enzyme protocol. The levels of enzyme in patients with relapse were significantly lower than normal ones (P=0.0003). The PDH serum level was also evaluated by age and sex, which did not show any significant differences (P=0.86). 
Conclusion: In patients with relapsing B-cell lymphoma, the pyruvate dehydrogenase (PDH) enzyme serum levels were significantly lower than healthy subjects, but this difference was not related to age and gender. In the case of further studies and comparisons beyond this study, this enzyme could be a good candidate, used as an alternative diagnosis tool, in patients with recurrent lymphoma.