The involvement of the ovary in lymphomatous processes is rare, but ovary is the common site in the female genital tract to be involved by the hematological malignancies.
The occurrence of lymphomas primarily arising in the ovaries has long been debated since no lymphoid tissue is found in the ovaries. Involvement of the ovary by malignant lymphoma can be primary or secondary and is discovered incidentally during a workup for abdominal or pelvic complaints.
The Present case of ovarian lymphoma , presented as an ovarian mass with gastrointestinal symptoms with occult extra-ovarian disease. It is unusual to find a tumour of the reticulo endothelial system to present as ovarian neoplasm .With a few exceptions lymphoma of ovary is secondary to a primary lesion in intestines usually. Because of its rarity it is worthwhile to report this case -
Mrs. D.,25 years of age ,3rd para , presents with amenorrhea of one year , pain lower abdomen since one month and gradually increasing swelling since 15 days. Her previous menstrual cycle was normal. She had laparoscopic sterilization one year back. Her general condition was normal. On per abdomen examination spleen was found to be enlarged 4 cm. below costal margin, soft in consistency. There was no lymphadenopathy.
A mass of about 22-24 weeks gestational uterus size, firm in consistency was palpable. On bimannual examination, cervix was normal, uterus was retroverted, retroflexed parous size, anterior to uterus a firm mass felt filling lower abdomen and appearing to be arising from right angle of Uterus, fornices were free, discharge healthy.
Her fasting Blood Sugar was 92% , blood Urea 25mg% ,Serum alkaline phosphatase 11.2 , SGOT was 20.0 IU., SGPT 14.0 IU. Serum Total proteins were 6.0 gm% , Total serum Billirubin was 1.4mg% , X-Ray Chest P. A. View Was normal. Barium meal study was normal.
Abdomen opened ( Laparotomy ) by right para median incision . Uterus , left ovary and fallopian tube were normal. On Right side there was an irregular swelling arising from Ovary, solid in consistency. The capsule of Swelling was having Malignant infiltration involving peritoneum. Tumour was adherent on the posterior surface, same separated. There was frank bleeding from separated area.
Sub - Total Hysterctomy with left sided salpingo- oophrectomy with removal of right sided tumour was done. Post operative period was un eventful.
On Histological examination nothing abnormal was detected in uterus and tubes. In both ovaries , picture was suggestive of malignant Lymphoma,
Non Hodgkins diffuse Lymphocytic variety .
The occurrence of lymphomas primarily arising in the ovaries has long been debated since no lymphoid tissue is found in the ovaries. Involvement of the ovary by malignant lymphoma can be primary or secondary and is discovered incidentally during a workup for abdominal or pelvic complaints.
The Present case of ovarian lymphoma , presented as an ovarian mass with gastrointestinal symptoms with occult extra-ovarian disease. It is unusual to find a tumour of the reticulo endothelial system to present as ovarian neoplasm .With a few exceptions lymphoma of ovary is secondary to a primary lesion in intestines usually. Because of its rarity it is worthwhile to report this case -
Mrs. D.,25 years of age ,3rd para , presents with amenorrhea of one year , pain lower abdomen since one month and gradually increasing swelling since 15 days. Her previous menstrual cycle was normal. She had laparoscopic sterilization one year back. Her general condition was normal. On per abdomen examination spleen was found to be enlarged 4 cm. below costal margin, soft in consistency. There was no lymphadenopathy.
A mass of about 22-24 weeks gestational uterus size, firm in consistency was palpable. On bimannual examination, cervix was normal, uterus was retroverted, retroflexed parous size, anterior to uterus a firm mass felt filling lower abdomen and appearing to be arising from right angle of Uterus, fornices were free, discharge healthy.
Her fasting Blood Sugar was 92% , blood Urea 25mg% ,Serum alkaline phosphatase 11.2 , SGOT was 20.0 IU., SGPT 14.0 IU. Serum Total proteins were 6.0 gm% , Total serum Billirubin was 1.4mg% , X-Ray Chest P. A. View Was normal. Barium meal study was normal.
Abdomen opened ( Laparotomy ) by right para median incision . Uterus , left ovary and fallopian tube were normal. On Right side there was an irregular swelling arising from Ovary, solid in consistency. The capsule of Swelling was having Malignant infiltration involving peritoneum. Tumour was adherent on the posterior surface, same separated. There was frank bleeding from separated area.
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| HYSTO PATHOLOGICAL VIEW |
On Histological examination nothing abnormal was detected in uterus and tubes. In both ovaries , picture was suggestive of malignant Lymphoma,
Non Hodgkins diffuse Lymphocytic variety .
Post operatively , patient was given Cyto toxic drugs alone, a complete course. , For follow up after 5 years , patient was doing well.
LOT OF THANX DR. SAHEB 4THIS POST I THINK THIS IS 4 ME
ReplyDeleteDr. Raghav,M., I went through the detailed presentation of Lymphoma of the ovary and also seen the blog. Such a treasure of knowledge, I have not seem before.
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Dr. Mukesh Raghav Ji , Sir I pray almighty for you or inturn us all for your creativity and wonderful presentation , which is quite suitable for the faculty.
ReplyDeleteFACULTY SALUTES YOU SIR!!
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Dr. Mukesh Raghav, I have casually gone through the blog. The factors worth appreciating are the beauty of blog, the material and particularly , yours latest post LYMPHOMA OF OVARY., is very educational.
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Dr.Raghav ,I feel proud on saying that you were and is my teacher. Just remembering my student life, you used to ask very difficult questions, but you always gave good marks to every one.Till date you are writting on blogs, that too with beautiful articles.
ReplyDeleteWhen I showed this blog of yours to my wife, again a student of yours, she only told " HE IS A GREAT TEACHER AND SURGEON TOO"
Regards from both of us.
Dr. Mukesh Ji , a very nice and beautiful blog with relevent photos and contents too. I am the happiest one today to remember that you were my student.
ReplyDeleteGod bless my dear.