Primary Ovarian Diffuse Large B-Cell Lymphoma Mimicking an Ovarian Malignancy: A case report
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Abstract
Background: Primary ovarian lymphoma is a rare extranodal lymphoma that can mimic primary ovarian malignancy, making preoperative diagnosis challenging.
Case Report: A 39-year-old woman presented with progressive abdominal pain and distension. Examination revealed a pelvic mass equivalent to a 24-week gravid uterus. Conventional ovarian tumour markers were normal, but lactate dehydrogenase was elevated at 1140 U/L. She underwent exploratory laparotomy, hysterectomy, bilateral salpingo-oophorectomy, pelvic lymph node dissection, and omentectomy for suspected ovarian malignancy. Histopathology revealed diffuse large B-cell lymphoma, non-germinal centre B-cell type. She received one cycle of R-CHOP, followed by five cycles of dose-adjusted R-EPOCH and two cycles of high-dose methotrexate, achieving complete response. She remains disease-free at three years.
Conclusion: Primary ovarian lymphoma should be considered in ovarian masses with disproportionately elevated lactate dehydrogenase despite normal conventional tumour markers. When lymphoma is clinically suspected, multidisciplinary evaluation should be undertaken, and preoperative ultrasound- or CT-guided tissue biopsy should be considered if imaging demonstrates a solid mass that is safely accessible for biopsy without increasing the risk of tumour spillage or disease upstaging. Intraoperative frozen-section may also play a valuable role, where available, in guiding surgical decision-making and avoiding unnecessary extensive debulking surgery.
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