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CASE REPORT Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 4  |  Page : 528-530
Extranodal non-Hodgkin's lymphoma presenting as an ovarian mass


1 Department of Pathology, Bankura Sammilani Medical College, Bankura, West Bengal, India
2 Department of Forensic Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India

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   Abstract 

An 8-year-old female presented with an abdominal lump. A ultrasonography showed a heterogeneous, mainly solid space-occupying lesion with few cystic components and irregular margin in both adnexae measuring 10.5 x 5.2 x 3.5 cm and 9.2 x 4.8 x 3.0 cm. The tumors were removed by exploratory laparotomy and the histopathological report was primary NHL of the ovary. The uterus and cervix were healthy and there was no tumor extension or omental deposit. The patient was referred for chemotherapy.

Keywords: Extranodal non-Hodgkin′s lymphoma, non-Hodgkin′s lymphoma, ovarian tumor

How to cite this article:
Ray S, Mallick MG, Pal PB, Choudhury MK, Bandopadhyay A, Guha D. Extranodal non-Hodgkin's lymphoma presenting as an ovarian mass. Indian J Pathol Microbiol 2008;51:528-30

How to cite this URL:
Ray S, Mallick MG, Pal PB, Choudhury MK, Bandopadhyay A, Guha D. Extranodal non-Hodgkin's lymphoma presenting as an ovarian mass. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 Mar 30];51:528-30. Available from: http://www.ijpmonline.org/text.asp?2008/51/4/528/43750



   Introduction Top


Lymphoma presents as an ovarian tumor in fewer than 1% of cases. [1],[2],[3] Although the clinical presentation here is as an ovarian tumor, lymphoma generally also involves the pelvic or abdominal lymph nodes, the liver or spleen, or other organs indicating that ovaries are involved as part of the disseminated disease. [3],[4] A few patients treated only by oophorectomy never develop extra-ovarian lymphoma, indicating that rare lymphomas are primary located in the ovaries. [3],[4] In children, most of the reported cases have been of the small, non cleaved cell type, either in the Burkitt or non-Burkitt category. Extra-ovarian involvement is found during a laparotomy in approximately two-thirds of the patients with lymphoma. [5]


   Case Report Top


An 8-year-old female patient attended the pediatric out patient department (OPD) complaining of pain and swelling in the lower abdomen. Upon clinical examination, an ill-defined mass was palpable in the lower abdomen. The abdomen felt doughy, but there was no obvious presence of free fluid. The patient was anemic, normotensive and had generalized poor health. The liver and spleen were not palpable.

Investigation

A hematological profile of the patient was normal except for a hemoglobin level of 7 gm%. RBC morphology was hypochromic microcytic; the erythrocyte sedimentation rate (ESR) was 30 mm in the first hour. A plain x-ray of the abdomen was not informative. An ultrasonography (USG) of the entire abdomen revealed a heterogeneous, mainly solid, space-occupying lesion with few cystic components and irregular margins in both adnexae, measuring 10.5 x 5.2 x 3.5 cm and 9.2 x 4.8 x 3.0 cm.

Management

An exploratory laparotomy was performed, which revealed bilateral ovarian tumors measuring 10.2 x 5.0 x 3.1 cm and 9.5 x 4.5 x 2.5 cm. The tumors were grayish-white in color, homogeneous and firm in consistency. There was no residual normal ovarian tissue. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. The abdomen was closed after peritoneal toileting. The entire operated specimen as well as tissue from the broad ligament and omentum were sent for histopathological examination.

Pathological findings

Grossly, the ovarian tumors were smooth, grayish-white in color, homogeneous and firm in consistency. The cut surface was fleshy [Figure 1].

Microscopically, the uterus,  Fallopian tube More Detailss, broad ligament and omentum were uninvolved by the tumor. After extensive sampling, the sections from both ovarian tumors showed a monotonous population of lymphoid cells in a single-file arrangement. The cells were uniform and round with scanty basophilic cytoplasm and coarse chromatin often with 1-3 nucleoli. Mitotic figures were present. A thin rim of compressed ovarian tissue was also present [Figure 2]. Immunohistochemistry (IHC) showed a positive reaction of the tumor cells for leukocyte common antigen (LCA) [Figure 3] and the B lineage marker CD 20 [Figure 4]. The tumor cells were negative for the T lineage marker CD3 [Figure 5]. On the basis of microscopic findings supported by IHC, a diagnosis of primary Non-Hodgkin's Lymphoma of the ovary was made.


   Discussion Top


Leukemia and lymphoma together account for over 40% of the malignant disorders in childhood. [6] The ovaries contain a tumor in approximately 25% of patients with Non-Hodgkin's Lymphoma during autopsy and in up to 50% of those with leukemia. [5] With the exception of Burkitt's Lymphoma, ovarian involvement as the initial manifestation of lymphoma or leukemia is rare. Primary lymphomas affecting the female reproductive system are uncommon but often pose a diagnostic challenge if their existence is not suspected. [7] Malignant lymphoma in the ovary may be confused with other primary ovarian tumors. It should be noted that diffuse infiltration of the adjacent Fallopian tube and/or broad ligament is much more common in lymphomas than in most of the tumors in the differential diagnosis. Dysgerminomas may be indistinguishable on gross examination from malignant lymphomas.

However, only 10% of dysgerminomas are bilateral in contrast to 50% of lymphomas. Moreover, on microscopic examination, the nuclei and immunohistochemical features are strikingly different.

Lymphomas may simulate metastatic carcinoma, particularly in the breast. Diffuse lymphoma can resemble undifferentiated carcinoma or granulosa cell tumor on low magnification. Numerous immunohistochemical markers are available to identify tumors as lymphomas. Granulocytic sarcomas should be considered when one is evaluating cases of suspected ovarian lymphoma. They can be distinguished with chloracetate esterase staining or more accurately, by immunostaining for myeloperoxidase. On routine stains, granulocytic sarcoma is often composed of cells with more finely dispersed nuclear chromatin and more abundant cytoplasm, which may be deeply eosinophilic, compared with lymphoma cells with nuclei of the same size.

 
   References Top

1.Osborne BN, Robboy SJ. Lymphomas or leukaemia presenting as ovarian tumours: An analysis of 42 cases. Cancer 1983;52:1933-43.  Back to cited text no. 1    
2.Monterroso V, Jaffe ES, Merino MJ, Medeiros LJ. Malignant lymphomas of the ovary: A clinicopathologic analysis of 39 cases. Am J Surg Pathol 1993;17:154-70.  Back to cited text no. 2  [PUBMED]  
3.Dimopoulos MA, Daliani D, Pugh W, Gershenson D, Cabanillas F, Sarris AH. Primary ovarian non-Hodgkin's lymphoma: Outcome after treatment with combination chemotherapy. Gynaecol Oncol 1997;64:446-50.  Back to cited text no. 3    
4.Fox H, Langley FA, Govan AD, Hill AS, Bennett MH. Malignant Lymphoma presenting as an Ovarian tumour: A clinicopathological analysis of 34 cases. Br J Obstet Gynaecol 1988;95:386-90.  Back to cited text no. 4  [PUBMED]  
5.Clement BP, Young HR, Scully ER. Miscellaneous primary tumours, Secondary tumours and non neo plastic lesions of the ovary. In: Mills S, Carter D, Greenson J, et al , editors. Sternberg's Diagnostic Pathology. 4 th ed. Philadelphia: Lppincott Williams and Wilkins; 2004. p. 2618.  Back to cited text no. 5    
6.Parker BR. Leukemia and lymphoma in childhood. Radiol Clin North Am 1997;35:1495-516.   Back to cited text no. 6  [PUBMED]  
7.Lagoo AS, Robboy SJ. Lymphoma of the Female genital tract - current status. Int J Gynaecol Pathol 2006;25:1-21.  Back to cited text no. 7    

Top
Correspondence Address:
Suchandra Ray
133 A, Block - B, Lake Town, Kolkata 700 089
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.43750

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

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