Saeed Amer.
Unusual presentation of primary gut Lymphoma.
J Postgrad Med Inst Jan ;17(1):137-9.

A 30 years old lady presented with abdominal masses, anorexia, loss of weight, amenorrhea and secondary infertility of one year duration. Although she already had two children but she wanted to have more keeping in view the local traditions. On examination, there was a mass in right flank, fixed, extending from pelvis unto right hypochondrium and medially just short of umbilicus. In addition, there were two small masses in the pelvis. Clinically ovarian pathology was diagnosed. Sonography revealed the two pelvic masses to be ovaries and a larger mass occupying right, paravertebral gutter, all other abdominal viscera and lymph nodes were clear from any pathology, giving the probability of hydatid disease. Casoni`s test was unremarkable, X-Ray chest was normal and hematological tests were normal. This lady was subjected to exploratory laparatomy. Operative findings were enlarged ovaries of cricket ball size, hard in consistency, freely lying in pelvis, with a mass of the same consistency had completely surrounded ascending colon right from ceacum up to hepatic flexure and adherent to posterior abdominal wall. Ovarian masses were completely free from colonic mass, all other abdominal organs were normal and the lymph nodes were not enlarged. Right hemicolectomy and illeotransverse anastomosis was performed and the right ovary was removed as the peroperative look of the masses was benign (the consent was not given for bilateral oopherectomy and hysterectomy). Operative diagnosis was primary ovarian pathology. Post-operative period was uneventful and the patient was discharged on 5th post-op day. Immunohistopathological examination of the both masses i.e. right ovary and ascending colon from Pathology Departments Combined Military Hospital Peshawar and Hayatabad Medical Complex, Peshawar came out to be Primary gut lymphoma, large cell type high grade with secondries in ovary. The lady was referred to Institute for Chemo-radiation and was followed by regular physical examination and abdominal sonography.

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