A 33 year old woman with human immune deficiency virus presented to the emergency room for the evaluation of abdominal pain. At laparotomy, she was found to have bilateral ovarian torsion. On final pathology, bilateral ovaries were found to be involved with Burkitt’s lymphoma.
Burkitt’s lymphoma is an aggressive form of B-cell non-Hodgkin lymphoma. It occurs most often in children and young adults and occasionally can involve the ovary. Malignant lymphoma of the ovary presents either as the primary tumor or, more commonly, as a site of disease metastasis. Autopsy series have demonstrated that the frequency of secondary ovarian involvement of Burkitt’s lymphoma is as high as 26%. Primary lesions of the ovary, however, are quite rare, accounting for only 0.5% of non-Hodgkin’s lymphomas and 1.5% of ovarian tumors. The symptoms of ovarian Burkitt’s lymphoma are nonspecific, but rapidly progressing abdominal distension has been reported in association with constitutional symptoms. We report a patient with Burkitt’s lymphoma presenting with acute abdominal pain and bilateral ovarian torsion.
Case Report
A 33 year old woman with human immune deficiency virus (HIV) presented to the emergency room for evaluation of right lower quadrant abdominal pain. She reported several weeks of chronic abdominal pain and bloating with severe episodic pain over the prior 3 days. She reported nausea and vomiting with the episodes of pain but denied other complaints including fevers, chills, dysuria, constipation, diarrhea, chest pain, and shortness of breath. Her medical history was notable for HIV diagnosed 10 years earlier and well controlled with highly active antiretroviral therapy (efavirenz, emtricitabine, and tenofovir). Her recent viral load was undetectable and the CD4 count was greater than 250.
Transvaginal ultrasound performed in the emergency room demonstrated bilateral edematous ovaries, the left measuring 8.9 × 7.9 × 5.7 cm, and the right ovary measuring 9.7 × 8.6 × 5.7 cm ( Figures 1 and 2 ) with normal arterial flow bilaterally noted on Doppler studies. A computed tomography scan also revealed nonspecific thickening of the cecum, appendiceal inflammation, and enlarged right pelvic lymph nodes ( Figure 3 ) with the remaining pelvic organs and retroperitoneal lymph nodes appearing unremarkable.
She was suspected to have ovarian torsion and underwent an exploratory laparotomy. Upon entry into the abdomen, the bilateral enlarged ovaries were found to be twisted on their pedicles numerous times. The ovarian tissue was friable and gelatinous and appeared to be nonviable ( Figure 4 ). Bilateral oophorectomy was performed. Further exploration of the abdomen revealed a solid mass involving the appendix, cecum, and mesentery and densely adherent to the right side wall, which was unable to be safely removed. Pathologic examination of both ovaries was consistent with Burkitt’s lymphoma. Histologic staining was positive for CD-20 and ki-67 ( Figures 5 and 6 ). A postoperative work-up revealed no other evidence of metastatic disease.
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