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Imaging revealed a large pelvic mass causing bilateral hydronephrosis, extensive lymphadenopathy and tumour lysis syndrome, managed with stents and supportive care. Re-evaluation of the biopsy established the diagnosis of primary endometrial diffuse large B-cell lymphoma (DLBCL). Hepatitis B positivity delayed chemotherapy; interim dexamethasone provided relief. Intensive chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and methotrexate\/ifosfamide, etoposide and cytarabine resulted in a rapid response but was complicated by neutropenic sepsis, leading to death. This case highlights the diagnostic challenge of endometrial DLBCL, the critical importance of pathological re-evaluation and the need for careful toxicity monitoring during intensive chemotherapy.<\/jats:p>","DOI":"10.1136\/bcr-2025-267013","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:35:16Z","timestamp":1777898116000},"page":"e267013","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Behind the bleeding: rare and relentless uterine lymphoma ending in chemotherapy toxicity"],"prefix":"10.1136","volume":"19","author":[{"given":"Ahmad","family":"Salameh","sequence":"first","affiliation":[{"name":"Internal Medicine, Shamir Medical Center, Tzrifin, Center District, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rama","family":"Shreim","sequence":"additional","affiliation":[{"name":"Beit Jala Hospital, Bayt Jala, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Shreim","sequence":"additional","affiliation":[{"name":"Pathology, Beit Jala Hospital, Bayt Jala, Palestine"},{"name":"Applied Professions and Science, Palestine Ahliya University, Bethlehem, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0160-3886","authenticated-orcid":false,"given":"Akram","family":"Karama","sequence":"additional","affiliation":[{"name":"Al-Quds University, Abu Dis, West Bank, Palestine"},{"name":"Hematology, Beit Jala Hospital , Beit Jala, Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"2026050405350947000_19.5.e267013.1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.radcr.2023.09.066","article-title":"Extranodal marginal zone lymphoma: A case report","volume":"19","author":"Romo","year":"2024","journal-title":"Radiol Case Rep"},{"key":"2026050405350947000_19.5.e267013.2","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1177\/87564793211054840","article-title":"Extranodal Non-Hodgkin Lymphoma: A Rare Presentation Involving the Pancreas","volume":"38","author":"Cerwin","year":"2022","journal-title":"J Diagn Med Sonogr"},{"key":"2026050405350947000_19.5.e267013.3","doi-asserted-by":"crossref","unstructured":"Papanastasiou L , Skarakis N , Vardaka M , et al . 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