Five cases of non-hodgkin B-cell lymphoma of the ovary

Primary lymphoma of the female genital tract masquerading as gynecological malignancy

BACKGROUND

Primary lymphoma of the female genital tract (PLFGT) is a rare malignant tumor in the female reproductive system, with a low incidence and few clinical reports. The aim of this study is to report our institutional experience with this rare malignancy and emphasize the need for increasing the awareness about PLFGT presenting with gynecologic symptoms.

METHODS

The medical records of patients diagnosed with PLFGT from March 2014 to November 2022 in the First Affiliated Hospital of Wannan Medical College were reviewed. Histological classification and staging were based on the World Health Organization and Ann Arbor systems, respectively.

RESULTS

There were 13 patients with diagnosis of PLFGT and the median length of follow-up was 31 months (0-102 months). The main clinical symptoms included postmenopausal vaginal bleeding, pelvic mass and abdominal pain. Serum LDH increased in 10 patients and serum CA125 elevated in 2 patients. The tumor of ovarian or uterine presented as solid masses in CT or MRI, and ascites was rare. The histological subtypes were diffuse large B-cell (n = 12) and follicular (n = 1) lymphoma. Tumors were located in ovary (n = 8), uterus (n = 3), and cervix (n = 2). According to the Ann Arbor staging system, 6 cases were classified as stage II and 7 cases were classified as stage IV, respectively. A total of 10 patients underwent surgery. Combination chemotherapy was used in 10 patients. Eight patients had tumor-free survival, 1 patient had recurrent disease, 3 patients died and 1 patient lost to follow-up. The median survival time was 32 months (1-102 months).

CONCLUSION

PLFGT usually presents as gynecological symptoms and solid masses in pelvis. Surgery or biopsy was the way to obtain the pathologic diagnosis, and combination chemotherapy is the efficient method for PLFGT. Making an accurate preoperative diagnosis is of paramount importance to avoid radical gynecologic surgery.

An Extranodal Site of Diffuse Large B-cell Lymphoma Presenting as Ovarian Cancer

Due to its uncommon nature, primary ovarian lymphoma has no clinical particularities and can be confused with other ovarian cancers. It poses a twofold diagnostic and therapeutic challenge. An anatomopathological and immunohistochemical study is the crucial step in the diagnosis. Our case was a 55-year-old woman diagnosed with an Ann Arbor stage II E ovarian non-Hodgkin's lymphoma who initially presented with a painful pelvic mass. This case reflects the major role of an immunohistochemical study in the diagnosis workup, leading to the appropriate management of such rare tumors.

Torquated large ovarian lymphoma as a cause of acute abdomen: a case report of diffuse large B-cell ovarian lymphoma with a germinal center B-cell-like phenotype

BACKGROUND

Ovarian lymphoma is a rare neoplasm and most commonly represents secondary ovarian involvement in overt systemic disease, usually of the non-Hodgkin's type.

AIM

To report a case of acute abdomen caused by torquated large ovarian lymphoma.

CASE REPORT

We report the case of 65-year-old patient admitted to our hospital with signs and symptoms of acute abdomen. Findings were suggestive of left ovary torsion due to the neoplasm. After detorsion, mobilization, and adhesiolysis, a bilateral adnexectomy was performed. Histopathological and immunohistochemical analysis of the left ovarian tumor was performed and diagnosis of diffuse large B‑cell lymphoma (DLBCL) with a GCB (germinal center B‑cell-like) phenotype was made. Additional bone marrow biopsy and imaging techniques excluded other sites of involvement, confirming diagnosis of primary ovarian DLBCL.

CONCLUSION

The prognosis of ovarian lymphomas may be poorer than for other lymphomas because of late diagnosis. The best treatment option appears to be systemic chemotherapy.

Immunohistochemical analysis using cell block technique leads accurate diagnosis of ovarian malignant lymphoma: A case report

INTRODUCTION

Ovarian malignant lymphoma is a rare gynecologic disease and some patients show marked ascites, similar to that observed in advanced ovarian cancer. Although radical surgery improves prognosis of ovarian cancer, treatment of lymphoma is based on chemotherapy, therefore, differential diagnosis is crucial.

PRESENTATION OF CASE

A 65-year-old woman presented with a 1-month history of abdominal distention. Pelvic ultrasonography showed an 11-cm solid mass in the pelvis. Computed tomography and magnetic resonance imaging revealed bilateral (mainly left) ovarian masses in the pelvis and multiple metastases. Laboratory examination revealed that serum CA125 levels were elevated, suggesting the existence of advanced ovarian cancer. To confirm the diagnosis, the ascites was removed via abdominocentesis. Although no malignant epithelial cells were observed, atypical lymphoid cells dispersed in the ascites were detected in the cytological analyses. Thus, for accurate diagnosis, we performed re-abdominocentesis and immunohistochemical (IHC) analysis using cell block technique. Cell block analysis showed negative staining for CD3 and positive staining for CD20 in large atypical lymphoid cells, suggesting the existence of large B-cell lymphoma. Repeat blood examination showed that the serum sIL-2R level was elevated. We decided to perform biopsy to make the final treatment decision. Histologically, the tumor demonstrated diffuse proliferation of large atypical lymphoid cells. IHC analysis showed CD3(-), CD5(+), and CD20(+). In addition, IHC analysis also showed CD79a(+), CD10(-), bcl-2(+), and cyclin D1(-). The final diagnosis was diffuse large B-cell lymphoma.

DISCUSSION AND CONCLUSION

Here, we present the case of a patient with ovarian malignant lymphoma that was diagnosed using cell block analysis.

Ovarian lymphoma in a patient on long-term sulfasalazine for ulcerative colitis

We report a case of ovarian lymphoma in a 59 year old woman with ulcerative colitis for over 20 years. She presented with intermittent high fever and right sided abdominal pain for 3 weeks. An ultrasound scan and CT scan revealed a right adnexal mass measuring 71 X 54 mm which was well defined with a thick wall and internal septations and enlarged pelvic and para aortic lymph nodes. The patient underwent bilateral salpingo oophorectomy and omentectomy. Histology confirmed a diffuse large B cell Non Hodgkin's lymphoma and she was referred for chemotherapy. After 6 cycles of chemotherapy she showed a good response. Lymphoma of the gastrointestinal tract arising in a background of ulcerative colitis has been known to occur, ovarian lymphoma with a background of ulcerative colitis has not been reported.

A Rare Case of Ovarian Follicular Lymphoma: Incidental Finding in a Woman With Postmenopausal Bleeding

Ovarian lymphoma is an uncommon malignancy with the incidence of primary ovarian lymphoma being ever rarer. Majority of patients with ovarian lymphoma tend to present with symptoms of abdominal distension, abdominal pain, loss of weight or appetite, and are usually found to have an ovarian mass. Postmenopausal bleeding (PMB) is not a symptom that is usually associated with ovarian pathology. This case report gives an account of how the patient presented to us, and the investigations and treatments offered that led to the final outcome.

An atypical presentation of an ovarian lymphoma: a case report

Background

Ovarian lymphoma has a varied clinical presentation and rarely presents with heavy menstrual bleeding. It may occur de novo or secondary to systemic disease and macroscopically appear as solid ovarian tumors.

Case presentation

A 32-year-old Tamil woman presented with heavy menstrual bleeding of 4 months’ duration. On examination she was anemic with no lymphadenopathy. A large immobile pelvic mass and three firm nodules were found involving her vaginal walls. Ultrasonography suggested a fibroid uterus with two large pedunculated fibroids. Following preoperative optimization an endometrial sampling and biopsy of the nodules were done. Subsequently, histology revealed proliferative phase endometrium. The vaginal nodules showed lymphoid tissue.

She presented a week later with an undulating fever and features of acute abdomen with clinical evidence of ascites. During an emergency laparotomy two large solid ovarian masses, gross ascites, pelvic lymph nodes, para-aortic lymph nodes, mesenteric lymph nodes, omental deposits, and a 24-week-size uterus were found. Bilateral oophorectomy was done. Laboratory investigations revealed raised lactate dehydrogenase with normal serum β-human chorionic gonadotropin, alpha-fetoprotein, and cancer antigen-125 levels. Histology of ovarian specimens revealed a diffuse large B cell lymphoma.

A bone marrow biopsy revealed more than 80% infiltration with lymphoid cells. Two weeks after the laparotomy a computed tomography of her chest, abdomen, and pelvis revealed a pelvic mass, gross ascites, omental deposits, hepatosplenomegaly, and enlarged lymph nodes above and below her diaphragm. Immunohistochemistry confirmed the diagnosis of B cell lymphoblastic lymphoma. She was classified as stage IV E non-Hodgkin’s lymphoma on the Ann Arbor staging system.

Conclusion

This is an atypical presentation of an ovarian lymphoma. The atypical presentations of ovarian lymphomas can lead to diagnostic dilemmas.

Aggressive lymphoma presenting as dysphagia: A rare cause of dysphagia

Diffuse large B-cell lymphoma (DLBCL) can involve the esophagus from local spread, distant metastasis and very rarely can also be the primary site. Once DLBCL is diagnosed, caution should be exercised in further evaluation for local treatments of sites like adnexal masses as was seen in this case; sometimes it is DLBCL at atypical sites.

Uterine, but not ovarian, female reproductive organ involvement at presentation by diffuse large B-cell lymphoma is associated with poor outcomes and a high frequency of secondary CNS involvement

Involvement of the internal female reproductive organs by diffuse large B-cell lymphoma (DLBCL) is uncommon, and there are sparse data describing the outcomes of such cases. In total, 678 female patients with DLBCL staged with positron emission tomography/computed tomography and treated with rituximab-containing chemotherapy were identified from databases in Denmark, Great Britain, Australia, and Canada. Overall, 27/678 (4%) had internal reproductive organ involvement: uterus (n = 14), ovaries (n = 10) or both (n = 3). In multivariate analysis, women with uterine DLBCL experienced inferior progression-free survival and overall survival compared to those without reproductive organ involvement, whereas ovarian DLBCL was not predictive of outcome. Secondary central nervous system (CNS) involvement (SCNS) occurred in 7/17 (41%) women with uterine DLBCL (two patients with concomitant ovarian DLBCL) and 0/10 women with ovarian DLBCL without concomitant uterine involvement. In multivariate analysis adjusted for other risk factors for SCNS, uterine involvement by DLBCL remained strongly associated with SCNS (Hazard ratio 14·13, 95% confidence interval 5·09-39·25, P < 0·001). Because involvement of the uterus by DLBCL appears to be associated with a high risk of SCNS, those patients should be considered for CNS staging and prophylaxis. However, more studies are needed to determine whether the increased risk of secondary CNS involvement also applies to women with localized reproductive organ DLBCL.

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

The ovarian lymphoma is rare. Lymphoma presenting as an ovarian mass with initial manifestation is even rarer. We report a case of primary Non-Hodgkin's Lymphoma (NHL) of left ovary in a 52-year-old female presented with distension of abdomen and lower abdominal back pain. USG and CT-scan imaging suggested provisional diagnosis of ovarian tumour. The diagnosis of malignant lymphoma was made by histopathological examination of the excised tissue along with immunohistochemistry by using LCA, CD20, cytokeratin & CD3. The tumour was classified as diffuse large B cell lymphoma. Rarity of this lesion warrants its mention.