SHM Converge Scientific Abstract ePoster Gallery-Ascites With Bilateral Ovarian Masses and Peritoneal Carcinomatosis as a Unique Presentation of High-Grade B-Cell Lymphoma

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This case describes a 32-year-old woman with 1 month of abdominal pain, nausea, and bloating, found on CT to have bilateral ovarian masses, large-volume ascites, and peritoneal carcinomatosis with omental caking. She had no B symptoms such as fever, night sweats, or weight loss. Diagnostic paracentesis showed rare atypical CD20-positive cells. Flow cytometry revealed a monoclonal B-cell population expressing CD19, CD20, CD5, and CD10 with lambda light-chain restriction. FISH confirmed rearrangements of BCL2 and MYC, establishing a diagnosis of double-hit diffuse large B-cell lymphoma (DLBCL).<br /><br />She was treated initially with dexamethasone, then received dose-adjusted R-EPOCH chemotherapy with intrathecal methotrexate. After 6 cycles, PET-CT in March 2025 showed complete remission.<br /><br />The presentation highlights that DLBCL can rarely mimic advanced gynecologic malignancy, presenting with ovarian masses, ascites, and peritoneal carcinomatosis. The differential diagnosis for bilateral ovarian masses with ascites is broad and includes ovarian cancer, metastatic disease (Krukenberg tumor), primary peritoneal carcinomatosis, lymphoma, endometriosis, ovarian cysts, Meigs syndrome, ovarian hyperstimulation, tuberculous peritonitis, pelvic inflammatory disease with tubo-ovarian abscesses, and pseudomyxoma peritonei.<br /><br />The case also emphasizes the limited specificity of tumor markers such as CA-125. Although CA-125 may be markedly elevated in this setting, it reflects peritoneal irritation or inflammation rather than being diagnostic of ovarian cancer. Overall, lymphoma should remain in the differential when evaluating bilateral ovarian masses with ascites, and tissue/fluid diagnosis is essential for correct management.

Asset Subtitle

Lane E. Andrews

Meta Tag

Author List Lane E. Andrews, Maxwell Bressman MD

Category Clinical Vignettes

Concept Ovarian Mass

Concept Cirrhotic Ascites

Concept Diffuse Large B-Cell Lymphoma

Concept Double-Hit B-Cell Lymphoma

Concept Differential Diagnosis

Distinguished Non-Finalist

Presenter Organization Greenwich Hospital - Yale New Haven Health

Presenting Author Lane E. Andrews

Track Adult

Keywords

diffuse large B-cell lymphoma

double-hit lymphoma

ovarian masses

ascites

peritoneal carcinomatosis

CA-125

flow cytometry

BCL2 rearrangement

MYC rearrangement

R-EPOCH chemotherapy

Ovarian Mass

Cirrhotic Ascites

Diffuse Large B-Cell Lymphoma

Double-Hit B-Cell Lymphoma

Differential Diagnosis