Primary ovarian lymphoma with late involvement to the central nervous system

Background: Twenty percent of the cases of non-Hodgkin's lymphoma present as extranodal disease, with < 1% beginning primarily in the ovary. Symptoms of primary ovarian lymphoma are rarely present and for the most part are nonspecific. Clinical case: We present the case of a 22-year-old female with increased abdominal girth and pain persisting for 3 months. Abdominal and pelvic ultrasound examination and computerized tomography showed a right adnexal mass with high suspicion of malignancy. Laparotomy and right salpingo-oophorectomy were performed, and there was no evidence that the tumor had spread beyond the right ovary. Immunohistochemical study reported an intermediate-grade, diffuse large B-cell lymphoma affecting the right ovary. The patient received six cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) scheme. Complete remission was confirmed after treatment. Three months later the patient presented dizziness and left nystagmus. Central nervous system (CNS) infiltration was documented. She received radiotherapy and intrathecal chemotherapy. After a 24-month follow-up, there was no evidence of tumor. Conclusions: Primary ovarian lymphoma has been described in similar to 70 cases in the literature. None corresponded to secondary infiltration to the CNS. Our case reports the first case of primary ovarian lymphoma with CNS infiltration.