Primary Non-Hodgkin’s Lymphoma of the Ovary – A Case Report

Abstract

A 52-year-old female presented with chief complaints of distension of abdomen, lower abdominal back pain and generalized weakness from last three months. She was Gravida 4 & para 4 and she had attained menopause 8 years back. On examination, she appeared pale. On abdominal examination, a fixed, firm mass was palpable in the left hypochondrium. On speculum examination, cervix was high up and not visualized. On vaginal examination, the mass was felt in anterior and lateral fornices. There was no mass palpable in the pouch of Douglas. A clinical diagnosis of ovarian tumour was made. Haematological and biochemical profile was unremarkable, except mild anaemia. Chest X-ray showed no abnormality. Abdominal ultrasonography revealed large heterogeneous, mainly solid 15x10cm mass in left adnexal region [Table/ Fig-1]. CT-scan of abdomen showed a large enhancing mass lesion with hypodense areas in left tubo-ovarian region [Table/ Fig-2]. No lymphoadenopathy or organomegaly was present. Patient's consent was taken. Patient underwent for exploratory laparotomy and the specimen was submitted for histopathological examination. Gross finding consist of a single, firm, lobulated ovarian mass measuring 16 X 10 X 5 cm in size. External surface was smooth with occasional areas of haemorrhage [Table/ Fig-3]. On cut section, it was a multilobular mass with a soft to firm consistency and colour varying from grey to tan. Focal areas of haemorrhage and necrosis were seen [Table /Fig-4]. A portion of attached fallopian tube was identified. On microscopic examination, Haematoxylin and Eosin stained section showed uniform population of monomorphic tumour cells intersected by fibro-vascular septa. Individual tumour cells were round to oval with prominent nucleoli at places. High N/C ratio and focal areas of haemorrhage and necrosis was noted [Table/ Fig-5,6].The diagnosis of non-Hodgkin's lymphoma diffuse, large celltype was made on light microscopy which was later confirmed by

Follicular Lymphoma Involving Bilateral Ovaries Following Routine Hysterectomy and Bilateral Salpingo-Oophorectomy: An Incidental Finding

“…According to diagnostic criteria of primary ovarian lymphoma proposed by Fox et al, lymphoma should be limited to the ovary, with direct spread to the adjacent lymph nodes or structures, bone marrow aspiration, and peripheral blood smear should be negative, and metastatic involvement should be seen at least after months [6]. The difference between ovarian and extra-ovarian lymphoma is that the tumor cells stick to reticulin to form pseudo-acini and can grow in cords or nests in ovarian lymphoma [7]. B-cell NHL is the more frequently occurring lymphoma of both B-cell & T-cell NHL that occurs in the ovary.…”

“…Immunohistochemical markers classify the tumor as lymphomas. This can be determined by chloracetate esterase or myeloperoxidase staining [7]. Histological specimen with positive staining for leukocyte common antigen (LCA) differentiates malignant lymphoma from nonlymphoid neoplasm.…”

“…Pelvic NHL is very responsive to chemotherapy and doesn't require surgical staging and cytoreduction. Pre-operative biopsies can help in making a diagnosis [5][6][7][8][9].…”

Bilateral primary ovarian non-Hodgkin�s lymphoma and fertility preservation: 5-year follow-up

“…The ovarian involvement by malignant lymphoma may be as primary extranodal disease and the secondary involvement may be as an initial manifestation of clinically occult nodal disease or as a late complication of disseminated nodal lymphoma (1,6). Primary extranodal lymphoma is less aggressive as 5 years survival rate is estimated at 80%, whereas it is 33% in cases of secondary lymphoma (6,7).…”

“…However, diffuse large B-cell lymphoma is the most common subtype of NHL and the most common subtype of PONHL, as well (1,6). The presence of positive staining for LCA in the histological specimen distinguishes malignant lymphoma from non-lymphoid neoplasm.…”