Lymphoma
Young patients diagnosed with lymphoma should be counseled and informed about currently available fertility preservation options by fertility specialists. Oocyte cryopreservation, ovarian tissue cryopreservation, or a combination of the two techniques can be proposed for fertility preservation in post-pubertal patients. Ovarian tissue cryopreservation becomes the only option in pre-pubertal patients, and if chemotherapy can’t be delayed or is already started (1,2).
Lymphomas are also among the most frequent indication for ovarian tissue transplantation, since the risk of minimal residual disease in the ovary is considered extremely low. The only type of lymphoma that needs specific safety assessment before transplantation is Burkitt lymphoma. This is a rare B cell form of non-Hodgkin’s lymphoma, highly aggressive, with the ovaries most frequently affected in the female genital tract. It is thought to account for approximately 19% of adnexal lymphomas (3,4), so it is essential that ovarian tissue be screened for malignant cells before considering its reimplantation in these patients. Current screening methods include histology, immunohistochemical testing for disease-specific markers, fluorescence in situ hybridization, and PCR, as well as 6-month follow-up of immunodeficient mice transplanted with fragments of thawed ovarian tissue.
References:
- ISFP Practice Committee, Kim SS, Donnez J, Barri P, Pellicer A, Patrizio P, Rosenwaks Z, Nagy P, Falcone T, Andersen C, Hovatta O, Wallace H, Meirow D, Gook D, Kim SH, Tzeng CR, Suzuki S, Ishizuka B, Dolmans MM. Recommendations for fertility preservation in patients with lymphoma, leukemia, and breast cancer. J Assist Reprod Genet. 2012 Jun;29(6):465-8.
- Dolmans MM, von Wolff M, Poirot C, Diaz-Garcia C, Cacciottola L, Boissel N, et al. Transplantation of cryopreserved ovarian tissue in a series of 285 women: a review of five leading European centers. Fertil Steril. 2021 May;115(5):1102-1115.
- Kosari F, Daneshbod Y, Parwaresch R, Krams M, Wacker HH. Lymphomas of the female genital tract: a study of 186 cases and review of the literature. Am J Surg Pathol. 2005 Nov;29(11):1512-20.
- Perlman S, Ben-Arie A, Feldberg E, Hagay Z. Non-Hodgkin’s lymphoma presenting as advanced ovarian cancer–a case report and review of literature. Int J Gynecol Cancer. 2005 May-Jun;15(3):554-7.