Primary Non-Hodgkin’s Lymphoma of the Ovary – A Case Report

Case RepoRtA 52-year-old female presented with chief complaints of distension of abdomen, lower abdominal back pain and generalized weakness from last three months.She was Gravida 4 & para 4 and she had attained menopause 8 years back.On examination, she appeared pale.On abdominal examination, a fixed, firm mass was palpable in the left hypochondrium.On speculum examination, cervix was high up and not visualized.On vaginal examination, the mass was felt in anterior and lateral fornices.There was no mass palpable in the pouch of Douglas.A clinical diagnosis of ovarian tumour was made.Haematological and biochemical profile was unremarkable, except mild anaemia.Chest X-ray showed no abnormality.Abdominal ultrasonography revealed large heterogeneous, mainly solid 15x10cm mass in left adnexal region [Table /Fig- 1].CT-scan of abdomen showed a large enhancing mass lesion with hypodense areas in left tubo-ovarian region [Table /Fig- 2].No lymphoadenopathy or organomegaly was present.Patient's consent was taken.Patient underwent for exploratory laparotomy and the specimen was submitted for histopathological examination.Gross finding consist of a single, firm, lobulated ovarian mass measuring 16 X 10 X 5 cm in size.External surface was smooth with occasional areas of haemorrhage [Table /Fig- 3].On cut section, it was a multilobular mass with a soft to firm consistency and colour varying from grey to tan.Focal areas of haemorrhage and necrosis were seen [Table /Fig -4].A portion of attached fallopian tube was identified.On microscopic examination, Haematoxylin and Eosin stained section showed uniform population of monomorphic tumour cells intersected by fibro-vascular septa.Individual tumour cells were round to oval with prominent nucleoli at places.High N/C ratio and focal areas of haemorrhage and necrosis was noted [Table /Fig- 5,6].The diagnosis of non-Hodgkin's lymphoma diffuse, large celltype was made on light microscopy which was later confirmed by