PMC5398115_01
(a) Two-dimensional gray scale ultrasonography showing two solid homogeneous hypoechoic masses lying behind the uterus and separate from it, (b) Doppler ultrasonography showing significant vascularity of the mass, (c) computed tomography scan showing two large solid masses arising from bilateral ovaries, with no ascites or lymphadenopathy, (d) magnetic resonance imaging showing two large solid homogeneous masses, right > left, hypointense on T1W1 imaging, (e) magnetic resonance imaging showing two large solid homogeneous masses, right > left, hyperintense on T2W1, (f) preoperative noncontrast computed tomography brain showing showed multiple ill-defined hypodensities in the right para-sagittal, right middle cerebral artery and posterior fossa, (g) postoperative magnetic resonance imaging brain showing an increase in size of the space occupying lesion in the right subcortical (para-sagittal) area measuring 2.5 cm x 3.0 cm
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F1
Transabdominal ultrasonography revealed bilateral solid ovarian masses [Figure 1a], measuring 13.9 cm x 11.8 cm on right side and 10.0 cm x 6.3 cm on left side, with significant vascularity on color Doppler [Figure 1b]. Computed tomography (CT) revealed two large solid masses arising from bilateral ovaries, with no ascites or lymphadenopathy [Figure 1c]. Magnetic resonance imaging (MRI) abdomen and pelvis were done for further delineation, which showed two large solid homogeneous masses, right > left, hypointense on T1W1 [Figure 1d] and hyperintense on T2W1 imaging [Figure 1e], with a normal sized uterus and no ascites. CT brain showed multiple ill-defined hypodensities in the right parasagittal, right middle cerebral artery and posterior fossa [Figure 1f], suggestive of? infarcts/?demyelination. MRI brain showed an increase in size of the space occupying lesion in the right subcortical parasagittal area measuring 2.5 cm x 3.0 cm [Figure 1g], with diffuse brain edema.
(a) Intraoperative finding showing enlarged bilateral ovaries, arrow pointing to enlarged left fallopian tube, (b) total abdominal hysterectomy with bilateral salpingo-oophorectomy specimen, arrow pointing to enlarged left fallopian tube, (c) cut section showing predominantly solid, homogenous, gray-white ovary with few small cysts and areas of hemorrhage, (d) on low power microscopy, ovary shows diffuse dense infiltrate of monomorphic neoplastic lymphoid cells with intact capsule (arrow), (e) low power microscopy of the left fallopian tube showing diffuse dense infiltrate of monomorphic neoplastic lymphoid cells consisting of medium-sized cells with round to oval nuclei, finely dispersed chromatin, and single to multiple small nucleoli, (f) immunohistochemistry showing tumor cells were diffusely and strongly positive for Tdt, (g) immunohistochemistry showing tumor cells were negative for B-cell marker CD-20
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F2
Total abdominal hysterectomy with bilateral salpingo-oophorectomy [Figure 2a and b] along with infracolic omentectomy was done. On cut-section, both the ovaries were predominantly solid, homogenous, gray-white, soft in consistency with few cysts and areas of hemorrhage [Figure 2c]. On microscopy, both ovaries and left tube [Figure 2d and e] showed diffuse dense infiltrates of monomorphic neoplastic lymphoid cells consisting of medium-sized cells with round to oval nuclei, finely dispersed chromatin and single to multiple small nucleoli. BCL2, and CD-10 [Figure 2f], and negative for B-cell markers - CD-20 and CD-79 [Figure 2g], with a very high proliferative index (MIB1 - 95%-100%). Bone marrow was negative for infiltration by lymphoblastic cells.