Primary pelvic diffuse large B-cell lymphoma misdiagnosed as a gynecological tumor: A case report and literature review

To investigate the clinical features, diagnostic challenges, and treatment strategies of primary pelvic lymphoma, aiming to enhance clinical recognition. A case of a 64-year-old female patient admitted due to "discovery of a pelvic mass for 3 months" is reported. Preoperatively diagnosed as a gynecological tumor, postoperative pathology confirmed diffuse large B-cell lymphoma (DLBCL, Stage IV). Her clinical manifestations, imaging characteristics, pathological diagnosis, and treatment course were analyzed in conjunction with a literature review. Preoperative imaging suggested a large mass (12.6 × 9.1 × 10.0 cm) in the right pelvis, leading to a presumptive diagnosis of ovarian cancer. The patient underwent exploratory laparotomy, total hysterectomy with bilateral salpingo-oophorectomy, and pelvic mass resection. Postoperative pathology combined with immunohistochemistry confirmed DLBCL. Postoperative complications included severe infection, poor wound healing, severe anemia, and electrolyte disturbances. Despite multidisciplinary efforts including aggressive anti-infection therapy, nutritional support, and blood transfusions, the patient's general condition remained poor, rendering her unable to tolerate chemotherapy. She was discharged at her family's request and died at home three months later. Primary pelvic lymphoma lacks specific clinical manifestations and is easily misdiagnosed as common gynecological malignancies. Preoperative core needle biopsy is crucial for definitive diagnosis and avoiding unnecessary surgery. For patients with advanced lymphoma, surgical value is limited, and perioperative management presents significant challenges, underscoring the importance of multidisciplinary collaboration and individualized treatment.