Malignant Lymphoma, which was Diagnosed by Pelvic Lymph Node Biopsy during a Total Laparoscopic Hysterectomy: Case Report

We report a rare case of a malignant lymphoma that was diagnosed by pelvic lymph node biopsy during a total laparoscopic hysterectomy for cervical carcinoma in situ (CIS). The patient was a 65-year-old woman with an unremarkable past history. She was referred to our hospital because a cervical cancer screening revealed a high-grade squamous intraepithelial lesion (HSIL). A cervical biopsy revealed squamous cell carcinoma in situ, which was confirmed by cervical conization. Moreover, she complained of an enlarged lymph node in her left neck. For this reason, she was referred to the department of otorhinolaryngology six days after the conization. Although fine-needle aspiration cytology of the cervical lymph node was performed twice, the results were negative. Because she refused a lymph node biopsy, antibiotics were given under the presumptive diagnosis of cat scratch disease. We recommended a total laparoscopic hysterectomy for the cervical CIS after providing informed consent. During the procedure, we biopsied a right obturator lymph node, which was noted to be enlarged with a pelvic MRI. Histologic examination revealed no residual tumor in the cervix; however, the lymph node was diagnosed as a grade 2 follicular lymphoma. She was subsequently diagnosed as a stage III malignant lymphoma (Ann Arbor classification) and is currently receiving R-CHOP chemotherapy in department of hematology. In our experience, laparoscopic lymphadenectomy is useful not only for the diagnosis of gynecological malignancies but also for the diagnosis of non-gynecological malignancies. Laparoscopic surgery can determine the cause of lymph node enlargement within the scope of less invasive surgery.