Non-Hodgkin´s B-lymphoma of the ovaries with an unfavourable prognosis – incidental finding during caesarean section

Czech version

Authors: M. Kopáčková ¹; P. Beránek ¹; I. Bydžovská ¹; R. Pytlík ²; J. Soukup ³; M. Mrhalová ³
Authors‘ workplace: Gynekologicko-porodnické oddělení, Krajská nemocnice Liberec, primář MUDr. P. Černý ¹; I. interní klinika – klinika hematologie, 1. LF UK a VFN, Praha, přednosta kliniky prof. M. Trněný, CSc. ²; Ústav patologie a molekulární medicíny 2. LF UK a FN Motol, Praha, přednosta prof. MUDr. R. Kodet ³
Published in: Ceska Gynekol 2018; 83(1): 45-49

Overview

Objective:
Presentation of a rare finding non-Hodgkin´s B-lymphoma of the ovary in a patient during caesarean section.

Design:
Case report.

Settings:
Department of Obstetrics and Gynaecology, Regional Hospital Liberec, a.s.; First Internal Clinic – Clinic of Hematology, First Faculty of Medicine and General University Hospital, Charles University in Prague; Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University in Praque and Motol University Hospital.

Results:
Pregnant woman, 31-years old, primiparous, with a history of caesarean section was examinated in our department due to nonspecific abdominal pain during her pregnancy. During the caesarean section of fetal indication we found bilateral ovarian tumours. We performed unilateral adnexectomy. Preliminary diagnosis from frozen section was thecoma, but final diagnosis (after definitive histology, imunohistochemistry and molecular investigation) was high-grade B-cell non-Hodgkin´s lymphoma with c-myc and bcl-6 gene rearrangement (double-hit lymphoma) resulting in an unfavourable prognosis. The patient consequently completed 6 cycles of chemotherapy with a biological treatment, and achieved a complete remission. However, after 6 months, an early generalisation to the CNS appeared, leading to intracranial hypertension refractory to anithypertensive and anti-oedematous therapy, consequently leading to death.

Conclusion:
Non-Hodgkin´s lymphoma of the ovary in pregnancy is a rare adnexal tumour whose treatment requires interdisciplinary cooperation.

Keywords:
non-Hodgkin‘s lymphoma, double-hit lymphoma, caesarean section, lymphoma in pregnancy, ovarian tumours

Sources

1. Ahmad, KA., Litkouhi, B., Azodi, M., et al. Institucional review of primary non-Hodgkin lymphoma of the female genital tract, a 33-year experience. Inter J Gynecol Cancer, 2014, 24, 7, p. 1250–1255.

2. Baser, E., Erkilinc, S., Esin, S., et al. Adnexal masses encountered during cesarean delivery. Inter J Gynaecol Obstet, 2013, 123, 2, p. 123–124.

3. Belada, D., Trněný, M. a kolektiv autorů Kooperativní lymfomové skupiny. Diagnostické a léčebné postupy u nemocných s maligními lymfomy, IX. vydání. ČLS JEP, 2016, s. 9–134.

4. Bhartiya, R., Kumari, N., Mallik, M., et al. Primary non-Hodgkin lymphoma of the ovary – a case report. J Clin Diagnostic Res, 2016, 10(5), p. 10–11.

5. Doubek, R., Petrová, D., Kalvodová, J., et al. Hematologické malignity v graviditě. Čes Gynek, 2009, 74, s.138–143.

6. Graham, GM. Adnexal masses in pregnancy: Diagnosis and management. Donald School J Ultrasound Obstet Gynecol, 2007, 1(4), p. 66–74.

7. Halaška, MJ., Rob, L., et al. Onkologická onemocnění během těhotenství. Praha: Mladá fronta, 2015, s. 14–18, 144–149.

8. Helwic, C. Understanding double-hit lymphomas and optimizing managment. Asco post, srpen 2016.

9. Horowitz, NA., Benyamini, N., Wohlfart, K., et al. Reproductive organ involvement in non-Hodgkin lymphoma during pregnancy: a systematic review. Lancet Onkol, 2013, 14, 7, p. 275–282.

10. Monterroso, V., Jaffe, ES., Merino, MJ., et al. Malignant lymphomas involving the ovary. Am J Surg Pathol, 1993, 17, p.,70–154.

11. Spencer, CP., Robarts, PJ. Management of adnexal masses in pregnancy. Obstet Gynaecol, 2006, 8, p. 14–19.

12. Swerdlow, S., Campo, E., Pileri, S., et al. The 2016 revision of the World Helth Organisation of lymphoid neoplasms. Blood, 2016, 127, 20, p. 2382.

13. Šuchová, K., Obrtlíková, P., Binder, T., et al. Burkittův lymfom v těhotenství – kazuistika. Čes Gynek 2010, 3, s. 248–251.

14. Vang, R., Medeiros, L., Warnke, RA., et al. Ovarian Non-Hodgkin´s Lymphoma: a clinicopathologic study of eight primary cases. Modern Pathol, 2001, 14, 11., p. 1093–1099.

15. Vydra, J., Cetkovský, P. Hematologie v kostce. Praha: Mladá Fronta, 2015, s. 181–207.

16. Weisz, B., Schiff, E., Lishner, M. Cancer in pregnancy: maternal and fetal implication. Hum Reprod Embryol, 2001, 7, 4, p. 384–393.

17. Zima, T. Laboratorní diagnostika, 2. vyd., Praha: Galén, 2007, s. 54, 385.