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Adv Biomed Res 2014,  3:71

Intraoperative diagnosis by frozen section study would prevent unnecessary surgery in ovarian Burkitt's lymphoma


1 Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication27-Jan-2014

Correspondence Address:
Azar Danesh Shahraki
Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-9175.125859

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How to cite this article:
Shahraki AD, Mohammadizadeh F, Zafarbakhsh A. Intraoperative diagnosis by frozen section study would prevent unnecessary surgery in ovarian Burkitt's lymphoma. Adv Biomed Res 2014;3:71

How to cite this URL:
Shahraki AD, Mohammadizadeh F, Zafarbakhsh A. Intraoperative diagnosis by frozen section study would prevent unnecessary surgery in ovarian Burkitt's lymphoma. Adv Biomed Res [serial online] 2014 [cited 2019 Oct 13];3:71. Available from: http://www.advbiores.net/text.asp?2014/3/1/71/125859

Sir,

Ovarian Burkitt's lymphoma is a rare form of malignant ovarian tumors accounting for 1% of all ovarian neoplasms. [1],[2],[3] It has been reported as a cause of ovarian torsion. [4] Herein, we briefly report a case of bilateral ovarian Burkitt's lymphoma in a 29-year-old woman presenting with vague suprapubic pain and abdominal distension. On physical examination, a rather large midline pelvic mass with abdominal extension was palpated. Serum beta hCG was negative and serum CA-125 level was within normal limits. Ultrasonography revealed homogenous and slightly echogenic large lobulated masses in both adnexae, each measuring approximately 10 cm in diameter. Pelvic and abdominal computed tomography confirmed the ultrasound findings and also detected enlarged paraaortic lymph nodes. The clinicoradiologic features of the tumor mimicked a primary malignant ovarian epithelial neoplasm despite the normal serum CA-125 level, and the patient became candidate for surgery. At surgery, peritoneal deposits and partial involvement of small intestine were also detected. The patient underwent surgical removal of the ovarian masses, paraaortic lymph node dissection, and peritoneal sampling. Permanent pathology revealed the ovarian masses to be Burkitt's lymphoma with the involvement of paraaortic lymph nodes and peritoneal seedings. The diagnosis was further confirmed by immunohistochemistry showing positive reactivity with leukocyte common antigen (LCA) and CD20 and CD10 markers. Following surgery, the patient underwent chemotherapy for Burkitt's lymphoma. However, an appropriate intraoperative management and diagnosis using tumor sampling and frozen section study would have avoided extensive and unnecessary surgery in this case. In fact, what made us consider extensive surgery was the presence of bilateral ovarian masses with diffuse peritoneal deposits and paraaortic lymphadenopathy, leading to an erroneous impression of primary malignant ovarian tumor originating from the surface epithelium.

The main treatment of ovarian lymphoma is chemotherapy, and the overall prognosis of the tumor is good. [5],[6] Spontaneous conception with live birth outcome has been reported following gonadotoxic chemotherapy for bilateral Burkitt's lymphoma. [7] The role of surgery is in question and debatable with the present available chemotherapeutic agents. [1] We do emphasize that, although rare, ovarian lymphoma should be considered in the differential diagnosis of advanced ovarian neoplasms, especially bilateral tumors in young women. Appropriate intraoperative management prevents unnecessary surgery in these cases.

 
  References Top

1.Cyriac S, Srinivas L, Mahajan V, Sundersingh S, Sagar TG. Primary Burkitt's lymphoma of the ovary. Afr J Paediatr Surg 2010;7:120-1.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Dimopoulos MA, Daliani D, Pugh W, Gershenson D, Cabanillas F, Sarris AH. Primary ovarian non-Hodgkin's lymphoma: Outcome after treatment with combination chemotherapy. Gynecol Oncol 1997;64:446-50.  Back to cited text no. 2
[PUBMED]    
3.Koffi KG, N'dathz E, Tolo A, Nanho DC, Meite N, Ayemou R, et al. Rare localisations of endemic Burkitt lymphoma: About 21 cases observed in the Haematology Department of the University Hospital of Yopougon Abidjan. Sante 2010;20:69-72.  Back to cited text no. 3
    
4.Taylor JS, Frey MK, Fatemi D, Robinson S. Burkitt's lymphoma presenting as ovarian torsion. Am J Obstet Gynecol 2012;207:e4-6.  Back to cited text no. 4
[PUBMED]    
5.Vang R, Medeiros LJ, Warnke RA, Higgins JP, Deavers MT. Ovarian non-Hodgkin's lymphoma: A clinicopathologic study of eight primary cases. Mod Path 2001;14:1093-9.  Back to cited text no. 5
    
6.Gutiérrez-García L, Medina Ramos N, García Rodríguez R, Barber MA, Arias MD, García JA. Bilateral ovarian Burkitt's lymphoma. Eur J Gynaecol Oncol 2009;30:231-3.  Back to cited text no. 6
    
7.Schüring AN, Nordhoff V, Schulte N, Kliesch S, Kiesel L, Berdel WE, et al. Spontaneous conception and live birth after gonadotoxic chemotherapy for an aggressive bilateral ovarian Burkitt's lymphoma. Eur J Obstet Gynecol Reprod Biol 2011;158:362-4.  Back to cited text no. 7
    




 

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