Non-Essential Intervention in the Management of Ovarian Burkitt Lymphoma: A Case Report

Abstract

Background: Ovarian involvement by Non-Hodgkins Lymphoma (NHL) may manifest within the four subtypes of lymphoma: diffuse large B-cell lymphoma, Burkitt lymphoma, lymphoblastic lymphoma, or anaplastic large cell lymphoma. Burkitt Lymphoma (BL) rarely manifests as a primary ovarian disease given the various epidemiological studies, putting the incidence at 0.5% of NHL and 1.5% of all ovarian neoplasm. Objective: This study is intended to highlight necessary intervention in the event of an uncommon manifestation of Burkitt lymphoma in a milieu of diagnostic challenges. Methods: A comprehensive review, and analysis of diagnosis, intervention and treatment of the index case was conducted by a team of health caregivers of the Federal Medical Centre, Bida, North Central Nigeria. Results: This review identifies a 15-year old female, with features suggestive of abdominal malignancy. In view of the associated severe abdominal discomfort, and pressure effects arising from the huge abdominal mass, the patient underwent exploratory laparotomy partly as a palliative measure to debulk as well as determining the extent of the local disease spread, and obtain tissue for histology.  Following a histological diagnosis of ovarian Burkitt lymphoma stage IIIB (St. Jude / Murphys staging), the patient was commenced on supportive therapy; a monthly course of intensive multi-agent (cyclophosphamide, Vincristine, Methotrexate) chemotherapy including intrathecal Methotrexate prophylaxis.  Haematologic remission was achieved by the end of the fifth cycle of the scheduled six cycles. Patient is currently well, and on hormone replacement therapy while being followed up at both the haematology and gynaecology clinics. Conclusion: Burkitt lymphoma (BL) as we have and seen in this case is highly responsive to standard high-dose chemotherapy, but it could be rapidly fatal if treatment is delayed. Although surgery is not considered as first line of treatment, but offers an opportunity for debulking and obtaining tissue biopsy for histological analysis. Standard multi-agent chemotherapeutic management remains the recommended first line choice in established case.