High-grade non-Hodgkin′s lymphoma of ovary presenting as peritonitis

Abstract

Primary ovarian lymphoma is rare, with ovary more commonly involved secondarily in generalized disease. Primary ovarian lymphoma presents as mass in the ovary with chronic symptoms; an acute presentation has not been described previously. A 75-year-old female presented with acute abdomen and features of peritonism. Computed tomography and magnetic resonance imaging demonstrated large mass in left ovary along with infiltration of adjacent sigmoid colon causing perforation and pneumoperitoneum. Few jejunal loops were also involved. Intraoperatively, there was left ovarian mass infiltrating the sigmoid colon with perforation and fecal peritonitis. Distal jejunal loops were adherent to the tumor. The involved sigmoid colon was resected with total abdominal hysterectomy, bilateral salpingo-oophorectomy and resection of adherent jejunal loops. Histopathology revealed ovarian tissue with necrotic neoplasm composed of small-to medium-sized round cells exhibiting nuclear irregularity and scanty cytoplasm, forming discohesive sheets with the neoplasm infiltrating the retroperitoneal remnant tissue and resected bowel. This case highlights an unusual presentation of primary ovarian lymphoma.

Ovarian Torsion as an Unusual Presentation of Primary Bilateral Ovarian Lymphoma

“…[2] It is hypothesized to occur in the lymphocyte within the ovarian blood vessels. [3] The criteria for diagnosing primary ovarian lymphoma as defined by Fox and Langley include (a) the disease to be limited to the ovary, (b) no evidence of disease in peripheral blood and bone marrow, and (c) a gap of few months before extraovarian deposits should appear, if any. However, if there is involvement of an adjacent organ or draining lymph node in the absence of systemic disease, the lymphoma is still regarded as primary ovarian lymphoma, as in our case.…”

“…However, if there is involvement of an adjacent organ or draining lymph node in the absence of systemic disease, the lymphoma is still regarded as primary ovarian lymphoma, as in our case. [3] The ovarian involvement can be unilateral or bilateral. Most patients present with a constellation of nonspecific symptoms including abdominal or pelvic pain, abnormal vaginal bleeding, nausea, vomiting, bowel obstruction, and abdominal mass with a rapid growth.…”

“…[1,2] This is due to the absence of lymphoid tissue within the ovary. [3] The presentation of ovarian lymphoma is often nonspecific with patient often presenting with ovarian mass and chronic symptoms such as pelvic pain, abnormal vaginal bleeding, bowel, and bladder symptoms. Here, we report a very rare case of primary bilateral ovarian lymphoma presenting as ovarian torsion.…”