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19 December 2013 - Case of the Week #295
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Thanks to Dr. Ankur Sangoi, El Camino Hospital (California), for contributing this case. This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.
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Case of the Week #295
A 50 year old woman presented with an ovarian mass, which was excised.
What is your diagnosis?
Diffuse large B-cell lymphoma
Most ovarian lymphomas are B cell tumors, as in this case, which was strongly CD20+ and showed marked proliferative activity with Ki-67 nuclear staining:
Left: CD20, right: Ki-67
Primary ovarian lymphoma is rare (Am J Case Rep 2012;13:96). Most ovarian B cell lymphomas are diffuse large B cell lymphoma or follicular lymphoma (PathologyOutlines.com > Ovary Tumor > Lymphoma). In the ovary, diffuse B large cell lymphoma may resemble a stromal tumor (particularly granulosa cell tumor the adult of and juvenile types) as well as germ cell tumors (mainly dysgerminoma). At all sites, diffuse large B cell lymphoma has a diffuse growth pattern of large CD20+ B cells (usually 5x normal lymphocytes) resembling immunoblasts (amphophilic cytoplasm, eccentric nuclei with one central nucleoli) or centroblasts (pale or basophilic cytoplasm, vesicular chromatin due to chromatin margination, 2-3 nucleoli, often near membrane). Occasionally neutrophils, histocytes or infiltrating T cells are prominent (PathologyOutlines.com > Lymphoma > Diffuse large B cell NOS). Touch preps show scattered large atypical cells in a background of small mature lymphocytes.
"Double hit" lymphoma has features intermediate between Burkitt lymphoma (with marked proliferative activity and a "starry sky" appearance) and diffuse large B cell lymphoma, including rearrangements of MYC, bcl6 and bcl2. In this case, molecular testing for these rearrangements were negative.
Treatment for low stage, primary ovarian disease is typically surgical and chemotherapy, with a good prognosis.
Nat Pernick, M.D., President
and Palak Thakore, Associate Medical Editor
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Alternate email: NatPernick@gmail.com