Ovarian lymphoma

Imaging of ovarian lymphoma

OBJECTIVE

The aim of the study is to describe the radiological spectrum of appearances of ovarian lymphoma (OL). The manuscript describes the radiological aspects of OL to assist the radiologist in achieving correct orientation of the diagnosis.

METHODS

We conducted a retrospective evaluation of imaging studies of 98 cases of non-Hodgkin's lymphoma, with extra-nodal localisation (ovaries) in three cases (1 primary, 2 secondary). A literature review was also performed.

RESULTS

Of the three evaluated women, one had a primary ovarian involvement and two had a secondary ovarian involvement. The most common lesion characteristics were a well-defined, solid homogeneous and hypoechoic mass at US. CT depicts OL as a well-defined, non-infiltrating, homogeneous hypodense solid mass, with mild contrast enhancement. On T1-weight MRI, OL appears as a homogeneous mass of low signal intensity, which enhances avidly following intravenous gadolinium.

CONCLUSION

Clinical and serological presentation of OL can be similar to that of primary ovarian cancer. As imaging plays a central role in the diagnosis of OL, the radiologist should be familiar with US, CT and MRI appearances of this condition to correctly orient the diagnosis and so avoid unnecessary adnexectomy.

Primary ovarian lymphoma: A case report

While Non-Hodgkin Lymphoma (NHL) often involves the ovaries at time of autopsy, it is rarely present at the time of diagnosis. Here we present a case of a 20-year-old who presented with a large adnexal mass and elevated B-HCG, CA-125, and LDH. The patient underwent exploratory laparotomy, and frozen section of the left ovarian mass was suspected to be a dysgerminoma. Final pathologic diagnosis was Ann Arbor stage IVE Diffuse Large B-Cell Lymphoma, germinal center subtype. Patient is currently undergoing chemotherapy and has received the 3 of a planned 6 cycles of R-CHOP.

Double‑hit primary lymphoma (MYC and BCL2) in the bilateral ovary: A case report

Lymphoid neoplasm with 18q21.3/BCL2 and 8q24/MYC translocation to immunoglobulin genes as dual-hit lymphoma in female bilateral ovaries is rare and has a poor clinical outcome. The present study reported on the case of a 33-year-old female, who was admitted to the hospital due to lower abdominal distension aggravated during defecation but with no obvious inducement. The B-ultrasound revealed bilateral adnexal solid masses and the pathological examination indicated advanced B-cell lymphoma (HGBL) with MYC and BCL2 gene rearrangement. The patient then received R-CHOP treatment, but the effects were poor. Rare extranodal HGBL presentations with MYC and BCL2 rearrangement should be considered in the differential diagnosis of masses at unusual sites, such as the adnexa. Due to their aggressive nature, early and prompt recognition of these lymphomas is essential for appropriately administering therapies.

A Rare Case of Ovarian Double-Hit/Diffuse Large B-Cell Lymphoma: A Case Report and Review of Literature

Primary ovarian non-Hodgkin lymphoma is a rare lymphoma that is often associated with diagnostic delays, initial misdiagnosis, and inappropriate management. We report a case of ovarian diffuse large B-cell lymphoma (DLBCL) in a young female who initially presented with generalized fatigue, lower abdominal discomfort, and 40 pounds of unintentional weight loss. She subsequently had a computed tomography of abdomen done that showed fatty liver, hepatomegaly, and a left heterogeneous ovarian mass measuring about 4 × 4.2 cm. Transvaginal ultrasound was also done that showed a heterogeneous solid left adnexal mass measuring 7.4 × 5.6 × 6.6 cm. She subsequently had a total abdominal hysterectomy with bilateral salpingo-oophorectomy. Immunohistochemistry (IHC) showed the malignant cells expressing PAX5, CD20, and BCL2 with a Ki-67 proliferation index greater than 90%. The cells were negative for AE1/AE3, S100, CD30, and cyclin D1. Aggressive B-cell lymphoma fluorescence in situ hybridisation (FISH) panel was positive for rearrangement of BCL6 and MYC, with no evidence of BCL2 rearrangement, consistent with a double-hit high-grade B-cell lymphoma. Immunohistochemistry for BCL6 and MU M1 showed positive staining in the malignant cells. CD10 was negative. The staining profile was consistent with nongerminal center B-cell-like type of DLBCL. Ovarian lymphoma is a very rare entity; the presence of an enlarged ovarian tumor should raise the suspicion of ovarian lymphoma, and our case also emphasizes on the use of IHC markers in diagnosing the ovarian DLBCL.

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.

Primary ovarian Burkitt lymphoma: report of a case and review of literature

We report a case of primary ovarian Burkitt lymphoma that occurred in a 25-year-old woman. The patient complained of a mass in the right ovary discerned by physical examination 2 months prior. Ultrasound examination indicated that the right ovary was enlarged and abundant blood flow signals were observed. Right salpingo-oophorectomy was subsequently performed. Histology was characterized by diffuse sheets of monotonous medium-sized lymphoid cells with plentiful mitotic figures and apoptosis. Numerous tingible-body macrophages were found in the ovarian tissue, presenting a starry sky pattern. The tumor cells expressed CD20, CD10, BCL6 and MYC in the absence of BCL2. Ki-67 proliferative index was very high with a proliferation rate of near 100%. MYC (8q24) rearrangement was detected by fluorescence in situ hybridization (FISH) with no BCL2 (18q21) and BCL6 (3q37) gene rearrangements. Cumulative evidence established primary ovarian Burkitt lymphoma as the final histopathologic diagnosis with clinical stage I (FIGO). The patient received HyperCVAD chemotherapy after surgery and remained complete response (CR) for 18 months. We aim to provide insight into the future treatment of this rare but lethal disease.

Primary bilateral ovarian involvement in Burkitt's lymphoma with an adnexal Torsion-like manifestation: A case report

Burkitt's lymphoma (BL) is defined as a highly invasive B-cell lymphoma with a poor prognosis. Primary bilateral ovarian mass without involvement of other organs is a rare manifestation of BL. Our report was a case of an EBV positive Burkitt's lymphoma, which initially presented with ovarian mass and adnexal torsion.

Ovarian Non-Hodgkin Lymphoma Revealed by Bone Metastasis: A Rare Pediatric Case

Ovary involvement of non-Hodgkin lymphoma (NHL) is rare. We report a rare case of ovarian NHL during adolescence revealed by bone metastasis. The diagnosis of malignant lymphoma was established after adnexectomy and histological study of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient has been treated according to the LMB French protocol with good outcome after two years. Although NHL is a rare ovarian neoplasm, it is essential to establish an accurate diagnosis as early as possible for therapeutic purposes.

Ovarian Diffuse Large B-cell Lymphoma Initially Suspected Dysgerminoma Managed by Laparoscopic Staging Surgery

Ovarian diffuse large B-cell lymphoma (DLBCL) is rare. DLBCL is a complex type of lymphoma. The ovarian DLBCL usually harbor a favorable prognosis. We report a case of ovarian DLBCL that presented as an ovarian mass with lower abdominal pain and was managed using laparoscopic staging surgery. A 29-year-old female (gravida 2, para 0, abortion 2) with a history of polycystic ovarian syndrome with irregular medication control visited our clinic due to lower abdominal pain. Transvaginal ultrasound revealed a heterogeneous, septated mass over the left adnexa with a diameter of approximately 6 cm × 8 cm. The tumor marker CA 19-9 was elevated (65.77 IU/mL); CA125 and carcinoembryonic antigen were not elevated. Laparoscopic surgery with left salpingo-oophorectomy was first performed. Frozen section indicated dysgerminoma. Then, we continued staging surgery through bilateral pelvic lymph node dissection, para-aortic lymph node dissection, omentectomy, right ovary and peritoneum biopsy, and washing cytology. Ovarian tumor and para-aortic lymph nodes were positive for lymphoma. The tumor cells were positive staining for CD20, CD5, ki67, BCL-6, and MUM-1, which was associated with DLBCL. The patient was then consulted for oocyte preservation and referred to hematology for further chemotherapy. In conclusion, an ovarian lymphoma is a rare event. The presence of an enlarged ovarian tumor should raise the suspicion of ovarian lymphoma. To differentiate ovarian lymphoma from dysgerminoma, immunohistochemistry is useful. Fertility preservation should be considered before chemotherapy. Ovarian tissue or oocyte preservation or gonadotropin-releasing hormone agonist injection before chemotherapy can be performed for fertility preservation.

Burkitt Lymphoma Mimicking Advanced Stage Ovarian Carcinoma

Lymphoproliferative disorders presenting with clinical features similar to ovarian tumors are a rare clinical condition. Even though lymphomas of ovarian origin are rare, they should be considered during the differential diagnosis of tumors of ovarian origin. In this case report, we aimed to present a case of Burkitt lymphoma that mimics advanced ovarian carcinoma.

Imaging features of immune-mediated genitourinary disease

PURPOSE

Imaging features of immune-mediated genitourinary diseases often overlap, and the same disease may manifest in different ways, so understanding imaging findings in the context of the patient's entire clinical picture is important in providing the correct diagnosis.

METHODS

In this article, diseases mediated by the immune system which affect the genitourinary system are reviewed. Examples of immune-mediated genitourinary disease including IgG4-related disease, post-transplant lymphoproliferative disorder, immunodeficiency-associated lymphoproliferative disorder due to immunosuppressive and immunomodulatory medications, lymphoma, leukemia, myeloma, amyloidosis, and histiocytosis.

RESULTS

Clinical and imaging features will be presented which may help narrow the differential diagnosis for each disease.

CONCLUSION

Recognition of immune-related genitourinary disease is important for appropriate medical management as they may mimic other diseases both by imaging and clinical presentation.

Primary bilateral ovarian Burkitt lymphoma; a rare issue in gynecologic oncology

We report a rare case of 42-year-old female patient with bilateral primary ovarian Burkitt lymphoma (BL). Primary BLs are rare ovarian oncology neoplasms. Only few cases are reported in English literature, most of them are presented in pediatric and young adult age groups. Rare cases are reported in adult females. Although BL is a rare primary ovarian neoplasm, it is very important to establish an accurate diagnosis as early as possible for therapeutic purposes.

Primary ovarian Burkitt's lymphoma: a rare oncological problem in gynaecology: a review of literature

Purpose

This review presents the information about epidemiology, clinical manifestation, diagnosis and treatment of primary ovarian Burkitt’s lymphoma (BL), including a literature search of available BL cases. The purpose of this review is to draw clinicians’ attention to the possibility of ovarian BL occurrence, which may be important in the differential diagnosis of ovarian tumours.

Methods

PubMed and Web of Science databases were searched using the keywords ‘‘Burkitt’s’’, ‘‘Lymphoma’’, ‘‘Ovarian’’, ‘‘Primary’’, ‘‘Burkitt’s lymphoma’’. Only cases with histopathologically confirmed diagnosis of primary ovarian BL were included in this review.

Results

Fifty articles, reporting cases with an ovarian manifestation of primary non-Hodgkin’s lymphoma, were found. Twenty-one cases with a histopathologically confirmed BL were evaluated to compare various manifestations, treatment and prognosis in ovarian BL.

Conclusions

Primary ovarian BL is a rare condition, included in the entity of non-Hodgkin lymphoma. The tumour can occur uni- or bilaterally in the ovaries with major symptoms such as abdominal pain or a large abdominal mass. Differential diagnosis, based on imaging features and pathological examination of the specimens, is essential for further treatment due to various aetiology of ovarian tumours. Although most of the patients suffering from ovarian BL underwent surgery after the ovarian tumour had been detected, surgical treatment is not the treatment of choice in patients with ovarian lymphoma. The mainstay of therapy is chemotherapy without further surgery. The prognosis is better if the chemotherapy protocol is more aggressive and followed by prophylactic central nervous system chemotherapy. Nowadays, multiagent protocols are administered, which improves the survival rate.

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

AIM

Primary ovarian non-Hodgkin's lymphoma is a very rare disease. Median age at diagnosis is estimated at 42 years, something that leads to fertility preservation issues in many cases. This was a case report study, presenting a rare case of bilateral primary ovarian non-Hodgkin's lymphoma.

CASE REPORT

A 38-year old nulliparous woman, underwent exploratory laparotomy because of bilateral ovarian masses. Left salpingooophorectomy, partial omentectomy and excision of an ovarian mass of the right ovary was performed. Great effort in order to preserve healthy ovarian tissue of the right ovary as well as the right fallopian tube was given, due to fertility reasons. Final histology showed bilateral diffuse large B-cell primary ovarian non-Hodgkin's lymphoma. Postoperatively, the patient underwent chemotherapy with the CHOP regimen in combination with rituximab. Five years after initial diagnosis, the patient remains well with normal menstrual cycle, without evidence of recurrence.

DISCUSSION

Fertility preservation issues in some cases of rare gynecological malignancies could be managed via minimally invasive oncological approach.

Female Genital Tract Involvement in Acute Lymphoblastic Leukemia: A Rare Case Report

Female Genital Tract (FGT) involvement with hematologic neoplasms is uncommon and the hematologic malignancies which involve the female genital organs are usually non-Hodgkin's lymphoma. Involvement of the uterus and cervix with Acute Lymphoblastic Leukaemia (ALL) is extremely rare, and ovarian involvement is even rarer. We report the case of a young lady who presented with tubo-ovarian mass, excessive post-operative bleeding (post-total abdominal hystrerctomy and bilateral salpingo-oophorectomy) and was diagnosed to have ALL with blood and tissue involvement by histopathology and flow cytometry.

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.

Primary ovarian non-Hodgkin lymphoma: Diagnosis of two cases on fine needle aspiration cytology

Lymphoma of the female genital tract is a rare condition. Involvement of the ovary by non- Hodgkin lymphoma (NHL) is usually secondary to systemic disease and primary ovarian lymphomas are unusual. In most cases, the diagnosis is not suspected initially and is confirmed only after detailed histopathological evaluation. We describe two cases of primary ovarian NHL which were diagnosed on fine needle aspiration cytology (FNAC). One of the patients was a 40 years old female who presented with abdominal distension and lump. She was found to have bilateral adnexal masses on ultrasound and computed tomography (CT) scan. A USG guided fine needle aspiration of the ovarian masses was performed, following which a diagnosis of primary ovarian diffuse large B-cell lymphoma was established. The second patient was a 14 years old female who presented with pelvic lump, which was lobulated and mildly enhancing on contrast enhanced CT. A diagnosis of high grade NHL of ovaries was made on cytology. Subsequently, the lymphoma was characterized as Burkitt's on histopathological examination. Both the patients were started on R-CHOP chemotherapy regimen. FNAC serves as an extremely useful minimally invasive procedure for the diagnosis of ovarian lymphomas and early institution of appropriate chemotherapeutic regimens.

Primary Burkitt's lymphoma of endometrium and bilateral ovaries in a 6-year-old female: report of a rare entity and review of the published work

We report a case of a 6-year-old girl with primary Burkitt's lymphoma (BL) of endometrium and bilateral ovaries of 1-month duration. To the best of our knowledge, few cases of childhood primary BL of bilateral ovaries have been reported worldwide. However, extensive search of the published work did not reveal any case of primary BL of endometrium and both ovaries. Although rare, BL is a potentially curable malignancy with good prognosis.

An atypical presentation of sporadic ovarian Burkitt's lymphoma: case report and review of the literature

Primary non-Hodgkin’s lymphoma of the ovary is a rare occurrence. An ovarian involvement by non-Hodgkin lymphoma (NHL) may include one of the four subtypes of lymphoma: diffuse large B-cell lymphoma, Burkitt’s lymphoma (BL), lymphoblastic lymphoma or anaplastic large cell lymphoma. Burkitt’s lymphoma is a rare entity with a specific poorly differentiated pattern.

Most women experience an ovarian BL with abdominal pelvic pain, abnormal vaginal bleeding, bowel obstruction, urinary frequency, incontinence and abdominal mass. Sometimes these warning signs may be absent, causing a late and more difficult diagnosis.

Here we report a case of a primary ovarian Burkitt’s lymphoma with bilateral involvement in a 57 year old patient. She firstly presented neurological symptoms in the upper limbs and she was treated with surgery and combined chemotherapy. The diagnosis of malignant lymphoma was established after bilateral adnexectomy and histological study of the excised tissue.

Natural history of primary precursor B lymphoblastic lymphoma of the ovary: report of a rare case

The involvement of the ovaries in lymphomatous processes is a relatively rare phenomenon. Secondary involvement as a part of systemic disease is common as compared to de novo primary lymphoma. Mostly, primary ovarian lymphomas are diffuse large B cell type, whereas the precursor lymphoblastic lymphomas are extremely rare and only four cases have been reported previously. We herein describe a case of primary precursor B lymphoblastic lymphoma involving both ovaries in a 28-year-old woman which was detected incidentally and spread into the blood after 7 months; consequently she succumbed to the disease.

Pelvic lymphoma: An unusual presentation

Pelvic lymphoma is not a common condition and aggressive recurrence of chronic lymphocytic leukemia (CLL) as a cause is rarely reported. We report a case of lymphoma of left adnexa in a postmenopausal woman, with a three week history of abdominal and left flank pain. Past medical history was consistent with diagnosis of CLL. She had received chemotherapy. Due to abdominal and flank pain and abdominopelvic mass, exploratory laparotomy was done with the impression of ovarian malignancy. A large uterus with adnexal mass and a large tumoral bladder was seen. Biopsy was done from adnexal mass which was compatible with lymphoma. The abdomen was closed and the patient was referred for chemotherapy. Lymphoma usually does not involve the pelvic organs. After laparotomy, her condition deteriorated and she expired.