Primary Ovarian Non-Hodgkin’s lymphoma (PONHL) is an extremely rare neoplasm with 43 cases reported worldwide. We report the first case of PONHL in the Philippines seen in a 21 year-old nulligravid presented with hypogastric pain, anemia and fever. Ultrasound showed a large subserous myoma while Magnetic Resonance Imaging revealed bilateral ovarian new growth, probably malignant. With persistence of anemia and patient’s deterioration, she underwent exploratory laparotomy with intraoperative findings of Bilateral Ovarian Cancer Intraoperative Stage IIIB. Considering the patient’s acute and rapid deterioration with no chance for fertility preservation, completion surgery was done through total abdominal hysterectomy with bilateral salpingo-oophorectomy, peritoneal fluid cytology, infragastric omentectomy, and appendectomy. Histopathology revealed round cell tumors of both ovaries positive for CD 45 and CD 20, confirming the diagnosis of Primary Diffuse Large B-cell Lymphoma. Our patient responded well to 6 cycles chemotherapy using Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisone (R-CHOP) regimen. Tibolone was given for hormone replacement therapy. Serial PET scan for 1 year showed no evidence of disease. Our case emphasizes the importance of clinical diagnosis and use of immunohistochemical markers in the diagnosis and management of POHNL. 

Camille Cayabyab is a resident of Obstetrics and Gynecology in Mariano Marcos Memorial Hospital and Medical Center, Ilocos Norte, Philippines. She finished her medical degree at New Era University, Quezon City, Philippines with Masteral Degree in Educational Management.