Plasma Cell-Rich Lymphoid Neoplasm in an Endocervical Polyp of the Uterine Cervix in a Perimenopausal 52-Year-Old Woman.

Background: The adaptive immune system consists of T and B lymphocytes, with some B lymphocytes further differentiating into plasma cells that secrete antibodies and make up the humoral immune system. Extramedullary plasmacytoma, mucosa-associated lymphoid tissue (MALT) lymphoma, and plasmablastic lymphoma are all plasma cell-rich lymphoid neoplasms that rarely present in the female genital tract. To date, few case reports of these malignancies arising within the uterine cervix exist.

Case Presentation: This case report describes a 52-year-old perimenopausal woman who presented to her primary obstetrician-gynecologist for an annual exam with the complaint of light spotting following an endometrial ablation that occurred several years prior. During the pelvic exam, we discovered and subsequently biopsied an endocervical polyp. The pathological examination of this polyp demonstrated atypical plasma cells and lymphocytes, indicating a leading diagnosis of extramedullary plasmacytoma. The results of further workup, which included a complete blood count, comprehensive metabolic panel, bone marrow biopsy, and a whole-body PET-CT scan, all came back negative for systemic disease. A surgical resection, including a total hysterectomy and bilateral salpingectomy, was performed. Bilateral ovarian conservation was performed due to this patient's perimenopausal status as well as the positive cardiovascular, cognitive, and bone benefits. A secondary pathology review of the endocervical polyp broadened the differential diagnosis to include MALT and plasmablastic lymphoma.

Conclusion: Extramedullary plasmacytomas, MALT lymphomas, and plasmablastic lymphomas carry a risk of progression to multiple myeloma and systemic disease, requiring close surveillance. A total hysterectomy is the most definitive treatment for confined neoplasms. Removing the bilateral ovaries in premenopausal or perimenopausal women places the patient in surgical menopause, which is vastly detrimental to the overall health of the patient. Therefore, thoughtful consideration regarding the benefits and risks of a bilateral oophorectomy versus ovarian conservation is imperative. Additionally, plasma cell-rich lymphomas are not estrogen-driven cancers like other gynecologic cancers, which support ovarian conservation.