We present a 34-year-old HIV positive woman who presented with a 2-month history of abdominal pain, abdominal distension, night sweats and fever. She had a firm, immobile and irregular abdominopelvic mass of about 30 weeks uterine size. Investigations showed a haemoglobin of 6.5g/dl, (NR 12-14) cancer antigen 125 of 44U/ml (NR 0-35), serum beta human chorionic gonadotropin (HCG) of 0.258mIU/ml (NR 0-5) and alpha fetoprotein of 7ng/ml (NR <10). Her CD4 count was 63cells/mm3. At laparotomy there was a left ovarian mass and the rest of the abdomen and omentum looked grossly normal, leading to the conclusion that the primary was in the ovaries. A total abdominal hysterectomy, bilateral adnexectomy and infracolic omentectomy were done. Sigmoidectomy and Hartmann's procedure were also performed. Histology of the specimens showed a large B cell lymphoma. She has since been commenced on chemotherapy and antiretroviral therapy and has been doing well.