Primary Ovarian Lymphoma Research Articles

Ovarian lymphoma

Ovarian lymphomas are rare. We reviewed three cases seen at our hospital to determine any similarities and outcome. The women presented with abdominal discomfort and swelling and were staged as stage I, II and IV. All three cases were B-cell lymphomas confirmed with positive staining with CD45 (LCA), CD20 (L26), CD 45 (4KB) CD45RA (MB1) and MB2 on immunohistochemistry. The two patients with more advanced disease died soon after treatment but the one with stage I (primary ovarian lymphoma) was still alive after 2 years. Ovarian lymphoma when detected late carries a poor prognosis.

A case of primary ovarian lymphoma with autoimmune hemolytic anemia achieving complete response with Rituximab-based combination chemotherapy

Ovarian involvement as primary or secondary lymphomatous process is extremely uncommon. In most cases, the diagnosis is usually not suspected initially and is confirmed only after detailed histopathological evaluation. We report a patient with primary ovarian diffuse large B-cell lymphoma (DLBCL) and associated auto-immune hemolytic anemia (AIHA) who achieved complete remission after treatment with Rituximab-cyclophosphamide-doxorubicin-vincristine and prednisolone (R-CHOP) chemotherapy. This patient was a 50 year old female, who presented with fever, abdominal pain, vomiting, weight loss and anemia. Computed tomography scan of the abdomen and pelvis revealed a large left ovarian mass with bilateral hydronephrosis. We performed exploratory laparotomy and partial resection of the mass was done due to the adhesions. Histopathology confirmed the diagnosis of DLBCL. After six R-CHOP chemotherapy cycles, patient achieved complete response with correction of anemia. To our knowledge, this may be the first case report till date of primary ovarian DLBCL with AIHA treated with R-CHOP chemotherapy who achieved complete remission in terms of primary disease as well as hemolytic anemia.

HIV Associated Non-Hodgkin’s Lymphoma of the Ovary

Non-Hodgkin’s lymphoma (NHL) may involve the gynecological tract, and the ovary is one of the most common anatomic site to be involved. Ovarian involvement by NHL is usually secondary, occurring as a part of systemic disease. Localized, presumably primary, NHL of the ovary is rare [1]. Although, there have been few case series of primary NHL of ovary, only one patient with AIDS-related primary ovarian lymphoma has been described in the literature [2].

Primary ovarian non-Hodgkin's lymphoma

Primary ovarian non-Hodgkin's lymphoma

Unusual primary ovarian tumour: non-Hodgkin malignant lymphoma: a case report

Non-Hodgkin primary ovarian lymphoma is an extremely rare tumour of which the histogenesis remains debated. Some authors consider it the manifestation of a generalized lymphoma disease. The prognosis is evaluated on the basis of the clinical stage, the histological type and the phenotype.Wepresent the case of a 13-year-old girl who presented with pelvic pain. Pelvic ultrasonography and tomography confirmed the ovarian origin. The diagnosis of B diffuse large cell lymphoma was established from the anatomic specimen after exploratory laparotomy and pathologic examination. Problems related to this rare entity are discussed in terms of diagnosis and therapy.

Clinical features and treatment outcomes of 14 cases of primary ovarian non-Hodgkin’s lymphoma: a single-center experience

To analyze the clinical characteristics, results of treatment, and prognostic factors of patients diagnosed as primary ovarian non-Hodgkin's lymphoma (PONHL). Fourteen cases of PONHL treated in Fudan University Cancer Center during a 10-year period were retrospectively reviewed, and the clinical data of the patients were analyzed for correlation between KPS, clinical stage, tumor size, IPI, ovary involvement, treatment and prognosis. The median age was 45 years, and thirteen patients were diagnosed of diffuse large B-cell lymphoma and one patient lymphoblastic lymphoma. Four patients were stage IE, three stage IIE, and seven stage IVE. The median tumor size was 8 cm (range, 4.0-15.0 cm). The median overall survival (OS) of the 14 patients was 23.0 months (range 11.5-71.2 months). Thirty-six percentage of patients with bilateral ovary involvement had a shorter survival time than those with unilateral ovary involvement (median OS: 19.0 vs. 37.2 months, P=0.014). The OS of Stage IVE was worse than stage IE and stage IIE (median OS: 18.75 vs. 37.5 months, P=0.047). Patients with IPI>2 had worse prognosis than those with IPI≤2 (median OS: 19.0 vs. 42.1 months, P=0.03). PONHL patient with larger tumor mass had worse prognosis (median OS: 19.1 vs. 37.2 months, P=0.019). R-CHOP regimens had a tendency to improve the OS but was not shown to be statistically significant (median OS: 22.4 vs. 37.2 months, P=0.436). The management of PONHL should be based on multi-modality treatment including surgery and chemotherapy. The significant prognostic factors of survival are tumor size, Ann Arbor staging, and IPI.

Cerebral leptomeningeal metastasis in a case of primary ovarian lymphoma

A 38 years old female patient is presented who applied to our neurosurgery clinic due to symptoms such as headache, ataxia, vertigo, vomiting and complaints related to a mass at the back side of her head. The examination of cranial magnetic resonance imaging (MRI) of the patient displayed a mass which obliterates the transverse sinus and extends from the scalp to the epidural space at a certain distance and to the occipital zone. The result of the biopsy report revealed an infiltration of malign lymphoma. The patient received cyclophosphamide, adriablastine, vincristine and prednisolone for 1 - 5 days, at 21 days interval and as 6 cures. A complete response was obtained at the end of the 3 rd cure. The patient was orientated for radiotherapy at the end of the sixth cure. This case is a rarely seen ovarian lymphoma and constitutes a sample for cerebral leptomeningeal metastasis which is a very rare condition. Key words: Cerebral leptomeningeal metastasis, primary ovarian lymphoma.

Clinical features and prognostic relevance of ovarian involvement in non-Hodgkin's lymphoma: A Consortium for Improving Survival of Lymphoma (CISL) report

Fourteen patients had primary ovarian lymphoma, while eighteen patients had secondary ovarian involvement. There was no significant difference in survival rates between primary and secondary involvement with diffuse large B-cell lymphoma (DLBCL), the most common subtype. The 5-year overall survivals of primary and secondary involvement with DLBCL were 70.0% and 59.3%, respectively. The localized bilateral ovarian involvement showed poorer survival compared to stage III/IV patients with secondary ovarian involvement. Treatment outcomes of secondary ovarian involvement in non-Hodgkin's lymphoma were comparable to those of primary ovarian involvement, suggesting that ovarian involvement does not necessarily predict a worse prognosis for NHL patients.

Non‐Hodgkin lymphoma presenting as an ovarian tumor

Sir, We came across a case where the initial manifestation of non-Hodgkins lymphoma was in the form of ovarian involvement. Involvement of the ovary by malignant lymphoma is well known as a late manifestation of disseminated nodal disease, but secondary ovarian involvement as initial manifestation of lymphoma is unusual (1). A 24-year-old woman, with one living child delivered six months previously, presented in emergency with the complaint of progressive abdominal distension for two weeks and pain for three days. A tender cystic mass with restricted mobility was felt in the lower abdomen. On vaginal examination the uterus was not felt separate from the mass. Ultrasonography showed ascites and a left adnexal mass, 18 × 20 cm in diameter, with variable echogenecity. CA-125 levels were 118.7 IU/ml. With the possibility of ovarian tumor torsion, exploratory laparotomy was done. There was ascites with bilateral solid ovarian masses each measuring 20 × 15 cm and multiple malignant deposits over the uterovesical peritoneum, uterosacral ligaments, left broad ligament, and omentum. Malignant deposits were also seen over the ileum, the largest 6 × 5 cm. Mesenteric lymph nodes were enlarged. The spleen, liver, diaphragm, and kidneys were normal. Total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, lymph node sampling, and ileal resection with end-to-end anastomosis was performed. Postoperative recovery was uneventful. Histopathology revealed undifferentiated high grade non-Hodgkins lymphoma (Figure 1) involving both ovaries, a segment of small intestine, and the mesenteric lymph nodes. Post-operatively chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone was planned. The patient was given two courses, which she tolerated well and did not come for follow-up after that. High-power view of the ovary showing monomorphic population of immature lymphoid cells with conspicuous nuclei. (H&E 400x) Malignant lymphomas frequently involve the ovaries at autopsy with a frequency of 7–26% (2). Less than 1% of patients with malignant lymphoma initially present with ovarian enlargement (3). The occurrence of lymphomas primarily in the ovaries is debatable. Fox et al. have proposed certain criteria for the diagnosis of primary ovarian lymphoma (4), such as confinement to the ovary and no abnormal cells in the peripheral blood and bone marrow. Ovarian lymphoma, whether a secondary manifestation of disseminated disease or truly primary in the ovary, is difficult to ascertain. Bilateral ovarian involvement, peritoneal implants, omental involvement, and metastasis in the intestine may be used as an argument against primary ovarian lymphoma in this patient. The prognosis depends on the clinical stage, modality of onset, histological type, and phenotype, with B-cell tumors having a better prognosis than T-cell/natural killer cell lymphomas (5). Debulking at the time of surgery followed by chemotherapy carries a good prognosis. Hence, we report this case to emphasize the presence of this entity.

Clinical Features and Prognostic Relevance of Ovarian Involvement in Non-Hodgkin's Lymphoma: a Consortium for Improving Survival of Lymphoma (CISL) Report.

Abstract 4999 IntroductionOvary can be involved as a primary ovarian lymphoma or secondarily involved by disseminated disease of non-Hodgkin's lymphoma. However, ovarian involvement is an extremely rare event in non-Hodgkin's lymphoma. Thus, it clinical features and prognostic relevance has rarely been addressed, and most publications refer to a single or a few cases. Thus, we retrospectively analyzed patients with ovarian involvement Patients and methods32 patients with ovarian involvement were assembled from 8 hospitals affiliated with the CISL (Consortium for Improving Survival of Lymphoma), a Korean lymphoma study group. Primary ovarian involvement was defined as a lymphoma confined to ovary with or without involvement of adjacent lymph nodes and contiguous organs. Secondary ovarian lymphoma was defined as a secondary involvement of ovary in disseminated disease of lymphoma at initial diagnosis. ResultsTwelve patients had primary ovarian lymphoma (37.5%) while twenty patients (62.5%) had secondary ovarian involvement by systemic disease. The clinical manifestations of ovarian involvement were similar to that of other ovarian tumors, namely an abdominal pain (31%), abdominal distension (19%) or lower abdominal palpable mass (16%). Pathological review according to the WHO classification showed that the most common histological subtype was diffuse large B-cell lymphoma (DLBCL, 75.0%, 24/32), and the frequency of other subtypes was as follows: Burkitt lymphoma (BL, 12.5%, 4/32), lymphoblastic lymphoma (6.3%, 2/32), marginal zone B-cell lymphoma (MZL, 3.1%, 1/32), peripheral T-cell lymphoma, unspecified (PTCL-U, 3.1%, 1/32). The median age (43 years, range 18-80) was younger than that of previously reported other organs such as uterus or prostate. The presence of B symptoms was only observed in 31.3%, and the performance status was good (84.4% of patients had less than grade II of ECOG performance status). The cases involving two or more than two extranodal sites were 68.8% while cases with elevated level of serum LDH were 59.4%. Thus, 59.4% of patients had the low or low-intermediate score of IPI score. Bilateral ovarian involvement was found in 12/32 (38%) while unilateral involvement was 20/32 (63%, 9 right and 11 left side. Three patients showed the involvement of central nervous system (CNS) at diagnosis (3/32, 9.4%). These three patients had DLBCL histology and unfavorable parameters including stage IV, high IPI score and bone marrow BM involvement. Thus, the initial CNS involvement might be associated with advanced stage of lymphoma not with ovarian involvement itself. Surgical removal of involved ovary was performed in 20 patients (62%), and then they were treated with systemic chemotherapy. Twelve patients (38%) were treated with chemotherapy alone. The comparison of outcomes according to the treatment modalities showed the outcomes of chemotherapy-based treatment versus surgery-based treatment were not significantly different (2 year overall survival; 66% vs. 68%). With a median follow-up of 25 months (range 3-185), 13 patients (40.6%) relapsed. Two patients were relapsed in single lesion and 11 were relapsed in multiple lesions. The majority relapsed at various extranodal sites (11/13, 84.6%) and only 2 cases relapsed at nodal sites. Most common relapse site was CNS (4 cases among 13 cases of relapse, 31%). All CNS relapsed patients had DLBCL histology. Ovarian relapse observed in one case that had been involved both ovary at the time of diagnosis. The 2 year overall survivals (OS) were 67% (95% CI: 50 to 83%) and the 2 year progression free survivals (PFS) were 61% (95% CI: 44 to 78%). In univariate analysis, high IPI score, 2 or more extranodal sites involvement and elevated LDH level were statistically significant parameters for lower PFS; moreover, 2 or more extranodal sites involvement and elevated LDH level associated with poor OS. ConclusionOvarian involvement of non-Hodgkin's lymphoma showed a dismal prognosis despite active treatment. Therefore, more optimal treatment strategy should be warranted. DisclosuresNo relevant conflicts of interest to declare.

A Rare Case of Primary Ovarian Lymphoma in Patients With Rheumatoid Arthritis: Can We Attribute This to Tumor Necrosis Factor Inhibitors?

Ovarian involvement as an initial manifestation of lymphoma is a rare occurrence. A literature search reveals that the current knowledge is limited to few case reports. Recently it has been suggested that the use of tumor necrosis factor inhibitors (TNFIs) is associated with increased incidence of malignant lymphomas. Herein, we present a case of primary ovarian lymphoma in a patient with severe rheumatoid arthritis receiving long-term treatment with TNFIs.

Primary ovarian Burkitt lymphoma

Primary ovarian Burkitt lymphoma (BL) is a rare neoplasm in adults. We report a 30-year-old woman diagnosed with primary bilateral ovarian BL. She presented features of a twisted ovarian cyst and underwent bilateral salpingo-oophorectomy. The histopathologic evaluation yielded the diagnosis of BL and subsequently she received chemoimmunotherapy with CODOX-M-IVAC plus rituximab (anti-CD20 monoclonal antibody).

Primary Ovarian Lymphoma: Report of Two Cases and Review of the Literature

Ovarian lymphoma is a rare entity. Clinicians should be aware of its clinical manifestations and management since surgery alone often is not adequate treatment. Here, we present two cases of ovarian lymphoma and discuss what is known about ovarian lymphoma.

Primary Precursor B-cell Lymphoblastic Lymphoma of the Ovary: Case Report and Review of the Literature

Primary ovarian lymphoma is a rare disease, and its definition is still controversial. Many cases of primary ovarian lymphoma are diagnosed as diffuse large B-cell type, whereas the precursor lymphoblastic type is extremely rare. Herein, we describe a case of precursor B-cell lymphoblastic lymphoma of the ovary that was successfully treated with surgery and chemotherapy. A 19-year-old woman presented ovarian tumors and paraaortic lymphoadenopathy, which were suggestive of advanced ovarian cancer. Exploratory laparotomy and right salpingo-oophorectomy were performed, and the diagnosis of precursor B-cell lymphoblastic lymphoma was established. The patient was treated with a combination of chemotherapy and is currently disease-free 1 year after surgery. To our best knowledge, this is the fourth reported case of precursor lymphoblastic lymphoma of the ovary.

Primary lymphoma of the ovary

Involvement of the ovary by malignant lymphoma is a well-known late manifestation of disseminated nodal disease. Primary ovarian lymphoma is rare. We report a case of primary ovarian non-Hodgkin's lymphoma with bilateral involvement which was managed by surgery and chemotherapy. A 29-year-old woman was admitted with signs and symptoms suggestive of an ovarian cancer. Computed tomography revealed an abdominal tumor measuring 20 cm in diameter, without enlarged lymph nodes. The diagnosis of malignant lymphoma was established after bilateral adnexectomy and histological study of the excised tissue. The tumor was classified as a diffuse large B-cell lymphoma. The patient has been advised 8 cycles of standard CHOP regimen and is presently on treatment. She has now been without disease for 7 months after the surgery. According to previous reports the treatment principles and prognosis of primary ovarian lymphoma is the same as that of other nodal lymphomas.

Primary non-Hodgkin's lymphoma of the ovaries: imaging findings

Primary ovarian lymphoma is very rare. We report a case of primary ovarian Burkitt-type non-Hodgkin's lymphoma, describing the imaging appearance on ultrasound, CT and MRI, and review the literature.

HIV-associated primary non-Hodgkin's lymphoma of ovary: A case report

Background. Although there have been few case series of primary non-Hodgkin's lymphoma (NHL) of ovary, no patient with AIDS-related primary ovarian lymphoma has been described in the literature. Case. We report a case of human immunodeficiency virus infected female with primary ovarian NHL for which she could not receive standard NHL combination chemotherapy and standard HIV highly active antiretroviral therapy (HAART) and succumbed to death within 7 months after diagnosis. Conclusions. Primary ovarian lymphoma is rare as compared with other ovarian tumors and has similar presentation to other common ovarian malignancies. The patients from developing countries cannot afford standard NHL combination chemotherapy and HAART as these drugs are expensive and are not provided freely to all patients, in state government run public hospitals.

A case of non-Hodgkin’s lymphoma of the ovary: Usefulness of18F-FDG PET for staging and assessment of the therapeutic response

Primary ovarian lymphoma as the initial manifestation is rare. A 27-year-old woman presented to our hospital with the symptoms of lower abdominal fullness and pollakisuria. CT scan and MRI revealed bilateral ovarian tumors, which showed heterogeneous masses. 18F-FDG PET revealed strong uptake by the abdominal masses, and the maximum standardized uptake value (SUVmax) was 12.5. Abnormal uptake was not shown by other regions. An exploratory laparotomy was performed. Histological findings revealed diffuse large B-cell lymphoma. The clinical stage was IV according to the Ann Arbor system. International prognostic index (IPI) was 3 (high-intermediate risk). Chemotherapy was administered consisting of three courses of an R-CHOP regimen, and 18F-FDG PET and CT scan revealed no signs of involvement 3 months after initiation of the chemotherapy. 18F-FDG PET was a useful method for staging and assessment of the therapeutic response in primary ovarian lymphoma.

A Case of Primary Ovarian Lymphoma in a Child With High Levels of CA125 and CA19-9

Primary ovarian lymphoma is extremely rare in children. The authors report a case of primary ovarian lymphoma in a child with high levels of CA125 and CA19-9. To their knowledge, this is the first such case to be reported in the literature.

Primary ovarian large B-cell lymphoma in patient with juvenile rheumatoid arthritis treated with low dose Methotrexate

Background Primary ovarian lymphoma is an extremely rare disease and limited count reports about it have been reported in the literature. Traditionally, patients with rheumatoid arthritis (RA) have increased risk of nodal and extranodal lymphoid malignancies such as non-Hodgkin's lymphoma (NHL). Recently, some studies have also reported association between patients with juvenile rheumatoid arthritis (JRA) treated with Methotrexate (MTX) and malignant lymphoma developing. Case We report a 17-year old JRA patient with primary ovarian diffuse large B-cell non-Hodgkin's lymphoma (NHL). The patient had seronegative (rheumatoid factor negative) poliarticular form of JRA and was receiving low dose weekly Methotrexate (MTX) during the past 2 years. Initial presentation was adnexial mass and chronic pelvic pain. The patient was treated with surgery and combined cytotoxic chemotherapy. Conclusion In conclusion, because of increased lymphoid malignancy risk, ovarian masses in JRA patients should be carefully evaluated.