Burkitt's lymphoma of the ovary

Burkitt's lymphoma of the ovary | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Burkitt's lymphoma of the ovary jie li, Ling Xi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1568279/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Burkitt’s lymphoma (BL) in female adults is rare, the initial presentation of BL as an ovarian tumor is even rarer. A 30-year-old woman presented to the clinic with complaints of distention and went on exploratory laparotomy and pathological examination showed the final diagnosis as BL. Then the patient went on one year of seven cycles of chemotherapy and autologous stem cell transplantation (ASCT), the patient remained disease-free for six years and kept follow-up since then. This study offers the insights in how to make the right and rapid diagnosis and treatment recipe for primary ovarian Burkitt’s lymphoma patients. Burkitt’s lymphoma ovarian cancer ovary lymphoma Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Burkitt lymphoma (BL), as an exuberant, rapidly aggressive, and unique B-cell neoplasm is the fastest growing human tumor, characterized by a translocation between c-myc and immunoglobulin heavy loci, such as t(8;14)(q24;q32), t(2;8)(p12;q24) or t(8;22)(q24;q11). BL is more likely to involve children, especially boys. In all BL patients, female adult patients are rare, primary ovarian Burkitt’s lymphoma is even rarer. Most primary ovarian Burkitt’s lymphoma patients’ symptoms are not classic “B cells” related, like fever, weight loss, and night sweating. The first reason for these patients may be gynecological signs and symptoms, like pelvis or an abdominal mass, abdominal pain, and distention. The delay for these patients to receive chemotherapy may negatively affect their prognosis. Cases reported the primary ovarian Burkitt’s lymphoma are extremely rare. The differential diagnosis between ovarian mass and Burkitt’s lymphoma is challengeable. Misdiagnosis as ovarian cancer may bring unnecessary chemotherapy, like paclitaxel, cisplatin, and carboplatin, and surgery like tumor debulking, hysterectomy, omentectomy, adnexal removal, and lymphadenectomy. Tumor removal may not be necessary as the pelvis mass in this patient disappeared after chemotherapy. Experience in treatment and diagnosis of patient in this case may offer the opportunities to make fast and perfect decisions for patients in the clinic. Methods 1 patient diagnosed as Burkitt’s lymphoma was followed in Tongji hospital in Hubei, China. The diagnosis of Burkitt’s lymphoma presenting as ovarian mass was established if the following criteria were met: 1. ultrasound sonogram finding of an endobronchial tumor 2. Histological evidence of lymphoma from biopsy of the lesion 3. Absence of extrapelvis lymphoma. Case Presentation A 30-year-old G2P2 female presented to the clinic, complaining of distention for half a month. She reported shortness of breath, but denied other complaints like nausea, vomiting, diarrhea, and chest pain. Her medical history was nothing notable. Transvaginal ultrasound performed showed bilateral edematous ovaries, the left measuring 4.8*4.6cm, and the right ovary measuring 8.0*5.9cm, and fluids in the abdomen. A Positron emission tomography-computed tomography (PET-CT) scan revealed high metabolism conditions in cardiocostophrenic angle, thickened peritoneum, pelvic mass, and right-side pleural effusion and ascites. (Image 1.) Laboratory test demonstrated serum levels of CA125 elevated to 2225.30 U/ml and CA199, CEA, AFP was within normal range. Complete blood and chemistry profiles were normal. Additionally, uric acid was 805 umol/L. She was suspected to have ovarian cancer and underwent an exploratory laparotomy. Upon entry into the abdomen, the greater omentum was found closely adherent to the peritoneal wall. Scattered friable metastasis was found all over the abdomen, prone to bleed after contact. No visible metastasis could be seen in the liver and the near space. Further exploration was discontinued for massive mass taken over all the pelvis space. Pathologic examination of the greater omentum and ascites was consistent with “starry sky” appearance that is typical of Burkitt’s lymphoma (Image 2). Histologic staining was positive for CD20, CD79𝛼, PAX-5, CD10, CD45, PAX-8, C-MYC, BCL-6, and Ki67, and negative for BCL-2, TdT, CD99, CD2, CD3, CK5/6, PR, S-100, PR and cyclin D1. Postoperative examination showed no evidence of metastatic disease. Then the patient begun combined chemotherapy including cyclophosphamide, doxorubicin, vincristine, and dacarbazine. Seven cycles of chemotherapy were continued for almost 1 year, and after that, the patient received autologous stem cell transplantation. Notably, after treatment, transvaginal ultrasound showed that no tumor-like disease was detected and mass in the pelvis. (Image 3 and 4) She was then discharged for follow-up once a year. It has now been over seven years since the diagnosis of Burkitt’s lymphoma was made. During this time, the patient remained disease-free. Discussion Burkitt’s lymphoma has a propensity to spread to extranodal sites like the central nervous system, bone marrow, mesentery, kidney, breast, testis, and ovary. ( 1 ) According to WHO classification, Common symptoms for sporadic type, include abdominal pain, distention, nausea, vomiting, and gastrointestinal bleeding. Common symptoms for endemic variants are jaw or periorbital swellings, or abdominal mass (like retroperitoneal tissue, gut, ovary, or kidney). ( 2 , 3 ) ( 4 ) Diagnosis for BL should be confirmed by microscopy and immunocytological analysis, and the recommended approach is biopsy of the disease-containing tissue. Common treatment principles include initial cytoreduction with various chemotherapy combinations. Contrary to the common BL, primary ovarian Burkitt’s lymphoma patients come with gynecology-related signs and symptoms. In the cases reported, most common symptom is abdominal pain. ( 5 – 8 ) some of them would accompany with classic “B cell symptoms” as fever, weight loss and night sweats. Chemotherapy recipes for primary ovarian Burkitt’s lymphoma follow with the common BL. Interestingly, as evidence in our case, laboratory exam like CA125 serum level alone is not a differential test between ovarian cancer and Burkitt’s lymphoma. CA125 elevation could be seen in both benign and malignant diseases, like endometriosis, pelvis inflammation disease, pulmonary tuberculosis, tuberculous peritonitis, and non-Hodgkin’s lymphoma(NHL), acute leukemia, hepatocellular carcinoma, melanoma, pancreatic tumors. ( 8 ) Additionally, high serum CA125 could be an important prognostic factor in NHL, correlating with advanced disease, low response rates, and worse survival. Patients with higher CA125 serum levels suffered from advanced disease, bone marrow involvement, extranodal involvement, poor performance status, the presence of B symptoms, and high serum lactate dehydrogenase (LDH) level. ( 9 ) CA125 measurements may be used for staging, monitoring response to treatment, and follow-up of patients with NHL. Furthermore, uric acid (UA) elevation has not been reported in this kind of cases. UA is associated with acute kidney failure and tumor lysis syndrome and an elevated UA level within the first 24 h of hospitalization was associated with a greater decline in eGFR 1 month after hospital dismissal.( 10 ) Patient in this case could be found obviously UA elevation, three times higher than normal highest limitation. UA elevation may be a promising differential diagnosis and prognosis factor. Prognosis factors in adult BL include advanced age, advanced stage, poor performance status, central nervous system (CNS) or bone marrow involvement, anemia, the presence of circulating blasts, and an LDH elevation. ( 1 ) Importantly, prognosis HIV features may not influence the prognosis of patients undergoing contemporaneous treatment. ( 11 ) Patients, both HIV infected or not, could have only pelvis mass-related symptoms in the cases reported before. ( 6 ) As the patient, in this case, survived till now, in-time diagnosis was made when no metastasis was found, and rapid chemotherapy went on. It is utmost important to make the right diagnosis for primary ovarian Burkitt’s lymphoma patients, since the rapid speed for BL invasion and metastasis. We could not find any patient who survived longer than the patient in this case among the past case reported. Chemotherapy with no delay in diagnosis and success in ASCT may help a lot. In this case, we could see that primary ovarian Burkitt’s lymphoma is highly mimicking ovarian cancer, and its diagnosis relies on pathological examination. Once diagnosed, further chemotherapy is needed. The primary pelvis mass will disappear as the chemotherapy went on. In conclusion, we could learn from this case that CA125 serum level elevation could happen to primary ovarian Burkitt’s lymphoma patients. The critical principal in treatment for primary ovarian Burkitt’s lymphoma patients could be no delay to undergo chemotherapy. Abbreviations BL Burkitt lymphoma ASCT autologous stem cell transplantation PET-CT Positron emission tomography-computed tomography CNS central nervous system NHL non-Hodgkin’s lymphoma LDH lactate dehydrogenase UA uric acid Declarations Acknowledgement The patient who is the subject of this case report gave verbal consent to be involved in this case report. All authors of this original manuscript have read and approved the revised version of the paper. Financial disclosure None to declare. Conflict of interest None to declare. Informed consent Not applicable Data availability The authors declare that data in this study are available within this article. References Blum KA, Lozanski G, Byrd JC. Adult Burkitt leukemia and lymphoma. Blood 2004;104:3009–3020. Jaffe ES. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology Am Soc Hematol Educ Program 2009:523–531. Mbulaiteye SM, Biggar RJ, Bhatia K, Linet MS, Devesa SS. Sporadic childhood Burkitt lymphoma incidence in the United States during 1992–2005. Pediatr Blood Cancer 2009;53:366–370. Patte C, Auperin A, Michon J, Behrendt H, Leverger G, Frappaz D, Lutz P, Coze C, Perel Y, Raphaël M, Terrier-Lacombe MJ; Société Française d'Oncologie Pédiatrique. The Société Française d'Oncologie Pédiatrique LMB89 protocol: highly effective multiagent chemotherapy tailored to the tumor burden and initial response in 561 unselected children with B-cell lymphomas and L3 leukemia. Blood. 2001 Jun 1;97(11):3370-9. Xu H, Zhao C, Wang Q, Chen Y, Zhang W, Zhuang Y, Chen R, Zhang H. Primary ovarian Burkitt lymphoma: report of a case and review of literature. Int J Clin Exp Pathol. 2022 Mar 15;15(3):110–119. Taylor JS, Frey MK, Fatemi D, Robinson S. Burkitt's lymphoma presenting as ovarian torsion. Am J Obstet Gynecol 2012;207:e4-6. Stepniak A, Czuczwar P, Szkodziak P, Wozniakowska E, Wozniak S, Paszkowski T. Primary ovarian Burkitt's lymphoma: a rare oncological problem in gynaecology: a review of literature. Arch Gynecol Obstet 2017;296:653–660. Allen GW, Forouzannia A, Bailey HH, Howard SP. Non-Hodgkin's lymphoma presenting as a pelvic mass with elevated CA-125. Gynecol Oncol 2004;94:811–813. . May HP, Mara KC, Barreto EF, Leung N, Habermann TM. Relationship between uric acid and kidney function in adults at risk for tumor lysis syndrome. Leuk Lymphoma 2021;62:3152–3159. Alderuccio JP, Olszewski AJ, Evens AM, Collins GP, Danilov AV, Bower M, Jagadeesh D, et al. HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis. Blood Adv 2021;5:2852–2862. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1568279","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":99636627,"identity":"b214cafc-743a-4044-b547-9acb9eb19814","order_by":0,"name":"jie li","email":"","orcid":"","institution":"Huazhong University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"jie","middleName":"","lastName":"li","suffix":""},{"id":99636629,"identity":"2b5a8bee-1fe7-4946-b70f-7e4711f4dd99","order_by":1,"name":"Ling Xi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACPgbGxgcMPAeATBBmYCashY2BsdngAFALDwlaGNgkDjCAtDAQq0Uiua36g8wdBnvG02kSDBXWiQ3sZw/g18JzsO3GAZ5nQFvObpNgOJOe2MCTl4BfC3sjSMthiBbGtsOJDRI8Bvi1MDO2FSC0/CNGC9AWBoSWBmK08BxsljjDc5iH58DZzRYJx9KN23hy8Gvhl0h/+KGy57Ac+4yzG298qLGW7Wc/g18LGDD2AN0FjB2GBAZwTBEDfoDsayBO7SgYBaNgFIw8AADgxURhXWCc5gAAAABJRU5ErkJggg==","orcid":"","institution":"Huazhong University of Science and Technology","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Ling","middleName":"","lastName":"Xi","suffix":""}],"badges":[],"createdAt":"2022-04-18 08:29:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1568279/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1568279/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":20612212,"identity":"697c1842-47a0-4d7d-a36b-be945ba9957e","added_by":"auto","created_at":"2022-04-21 16:18:13","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39922,"visible":true,"origin":"","legend":"\u003cp\u003ePositron emission tomography-computed tomography (PET-CT) of the pelvis mass and metastasis sites\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1568279/v1/937c4f828c3ea20825188533.jpg"},{"id":20612211,"identity":"5ab1ecd7-c860-4c96-8842-64d2bae30b20","added_by":"auto","created_at":"2022-04-21 16:18:13","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":346627,"visible":true,"origin":"","legend":"\u003cp\u003eOmental tissue hematoxylin and eosin stain\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1568279/v1/cd4adb28c2b87b01cadf09f5.jpg"},{"id":20612214,"identity":"e40aaf9b-ba48-49a5-aa23-17f7f89b5467","added_by":"auto","created_at":"2022-04-21 16:18:13","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":29087,"visible":true,"origin":"","legend":"\u003cp\u003eEndovaginal sonogram of right ovary\u003c/p\u003e","description":"","filename":"Fig3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1568279/v1/95b27a9cde33f39adc3cb23d.jpg"},{"id":20612620,"identity":"eb9e78b1-dafe-4612-85d2-d75222c11836","added_by":"auto","created_at":"2022-04-21 16:23:13","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":31730,"visible":true,"origin":"","legend":"\u003cp\u003eEndovaginal sonogram of left ovary\u003c/p\u003e","description":"","filename":"Fig4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1568279/v1/ea25127c0baa24d008173f81.jpg"},{"id":20612645,"identity":"8c51d3c1-125c-4cd5-90d1-4ac9d615bb30","added_by":"auto","created_at":"2022-04-21 16:23:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":476605,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1568279/v1/41ab178c-6b8d-48f9-9eab-388d19603df0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Burkitt's lymphoma of the ovary","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBurkitt lymphoma (BL), as an exuberant, rapidly aggressive, and unique B-cell neoplasm is the fastest growing human tumor, characterized by a translocation between c-myc and immunoglobulin heavy loci, such as t(8;14)(q24;q32), t(2;8)(p12;q24) or t(8;22)(q24;q11).\u003c/p\u003e \u003cp\u003eBL is more likely to involve children, especially boys. In all BL patients, female adult patients are rare, primary ovarian Burkitt\u0026rsquo;s lymphoma is even rarer. Most primary ovarian Burkitt\u0026rsquo;s lymphoma patients\u0026rsquo; symptoms are not classic \u0026ldquo;B cells\u0026rdquo; related, like fever, weight loss, and night sweating. The first reason for these patients may be gynecological signs and symptoms, like pelvis or an abdominal mass, abdominal pain, and distention. The delay for these patients to receive chemotherapy may negatively affect their prognosis. Cases reported the primary ovarian Burkitt\u0026rsquo;s lymphoma are extremely rare. The differential diagnosis between ovarian mass and Burkitt\u0026rsquo;s lymphoma is challengeable. Misdiagnosis as ovarian cancer may bring unnecessary chemotherapy, like paclitaxel, cisplatin, and carboplatin, and surgery like tumor debulking, hysterectomy, omentectomy, adnexal removal, and lymphadenectomy. Tumor removal may not be necessary as the pelvis mass in this patient disappeared after chemotherapy. Experience in treatment and diagnosis of patient in this case may offer the opportunities to make fast and perfect decisions for patients in the clinic.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e1 patient diagnosed as Burkitt\u0026rsquo;s lymphoma was followed in Tongji hospital in Hubei, China. The diagnosis of Burkitt\u0026rsquo;s lymphoma presenting as ovarian mass was established if the following criteria were met:\u003c/p\u003e\n\u003cp\u003e1. ultrasound sonogram finding of an endobronchial tumor\u003c/p\u003e\n\u003cp\u003e2. Histological evidence of lymphoma from biopsy of the lesion\u003c/p\u003e\n\u003cp\u003e3. Absence of extrapelvis lymphoma.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 30-year-old G2P2 female presented to the clinic, complaining of distention for half a month. She reported shortness of breath, but denied other complaints like nausea, vomiting, diarrhea, and chest pain. Her medical history was nothing notable. Transvaginal ultrasound performed showed bilateral edematous ovaries, the left measuring 4.8*4.6cm, and the right ovary measuring 8.0*5.9cm, and fluids in the abdomen. A Positron emission tomography-computed tomography (PET-CT) scan revealed high metabolism conditions in cardiocostophrenic angle, thickened peritoneum, pelvic mass, and right-side pleural effusion and ascites. (Image 1.) Laboratory test demonstrated serum levels of CA125 elevated to 2225.30 U/ml and CA199, CEA, AFP was within normal range. Complete blood and chemistry profiles were normal. Additionally, uric acid was 805 umol/L.\u003c/p\u003e \u003cp\u003eShe was suspected to have ovarian cancer and underwent an exploratory laparotomy. Upon entry into the abdomen, the greater omentum was found closely adherent to the peritoneal wall. Scattered friable metastasis was found all over the abdomen, prone to bleed after contact. No visible metastasis could be seen in the liver and the near space. Further exploration was discontinued for massive mass taken over all the pelvis space. Pathologic examination of the greater omentum and ascites was consistent with \u0026ldquo;starry sky\u0026rdquo; appearance that is typical of Burkitt\u0026rsquo;s lymphoma (Image 2). Histologic staining was positive for CD20, CD79\u0026#120572;, PAX-5, CD10, CD45, PAX-8, C-MYC, BCL-6, and Ki67, and negative for BCL-2, TdT, CD99, CD2, CD3, CK5/6, PR, S-100, PR and cyclin D1. Postoperative examination showed no evidence of metastatic disease.\u003c/p\u003e \u003cp\u003eThen the patient begun combined chemotherapy including cyclophosphamide, doxorubicin, vincristine, and dacarbazine. Seven cycles of chemotherapy were continued for almost 1 year, and after that, the patient received autologous stem cell transplantation. Notably, after treatment, transvaginal ultrasound showed that no tumor-like disease was detected and mass in the pelvis. (Image 3 and 4) She was then discharged for follow-up once a year. It has now been over seven years since the diagnosis of Burkitt\u0026rsquo;s lymphoma was made. During this time, the patient remained disease-free.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBurkitt\u0026rsquo;s lymphoma has a propensity to spread to extranodal sites like the central nervous system, bone marrow, mesentery, kidney, breast, testis, and ovary. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAccording to WHO classification, Common symptoms for sporadic type, include abdominal pain, distention, nausea, vomiting, and gastrointestinal bleeding. Common symptoms for endemic variants are jaw or periorbital swellings, or abdominal mass (like retroperitoneal tissue, gut, ovary, or kidney). (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Diagnosis for BL should be confirmed by microscopy and immunocytological analysis, and the recommended approach is biopsy of the disease-containing tissue. Common treatment principles include initial cytoreduction with various chemotherapy combinations.\u003c/p\u003e \u003cp\u003eContrary to the common BL, primary ovarian Burkitt\u0026rsquo;s lymphoma patients come with gynecology-related signs and symptoms. In the cases reported, most common symptom is abdominal pain. (\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) some of them would accompany with classic \u0026ldquo;B cell symptoms\u0026rdquo; as fever, weight loss and night sweats. Chemotherapy recipes for primary ovarian Burkitt\u0026rsquo;s lymphoma follow with the common BL.\u003c/p\u003e \u003cp\u003eInterestingly, as evidence in our case, laboratory exam like CA125 serum level alone is not a differential test between ovarian cancer and Burkitt\u0026rsquo;s lymphoma. CA125 elevation could be seen in both benign and malignant diseases, like endometriosis, pelvis inflammation disease, pulmonary tuberculosis, tuberculous peritonitis, and non-Hodgkin\u0026rsquo;s lymphoma(NHL), acute leukemia, hepatocellular carcinoma, melanoma, pancreatic tumors. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) Additionally, high serum CA125 could be an important prognostic factor in NHL, correlating with advanced disease, low response rates, and worse survival. Patients with higher CA125 serum levels suffered from advanced disease, bone marrow involvement, extranodal involvement, poor performance status, the presence of B symptoms, and high serum lactate dehydrogenase (LDH) level. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) CA125 measurements may be used for staging, monitoring response to treatment, and follow-up of patients with NHL.\u003c/p\u003e \u003cp\u003eFurthermore, uric acid (UA) elevation has not been reported in this kind of cases. UA is associated with acute kidney failure and tumor lysis syndrome and an elevated UA level within the first 24 h of hospitalization was associated with a greater decline in eGFR 1 month after hospital dismissal.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) Patient in this case could be found obviously UA elevation, three times higher than normal highest limitation. UA elevation may be a promising differential diagnosis and prognosis factor.\u003c/p\u003e \u003cp\u003ePrognosis factors in adult BL include advanced age, advanced stage, poor performance status, central nervous system (CNS) or bone marrow involvement, anemia, the presence of circulating blasts, and an LDH elevation. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Importantly, prognosis HIV features may not influence the prognosis of patients undergoing contemporaneous treatment. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) Patients, both HIV infected or not, could have only pelvis mass-related symptoms in the cases reported before. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) As the patient, in this case, survived till now, in-time diagnosis was made when no metastasis was found, and rapid chemotherapy went on.\u003c/p\u003e \u003cp\u003eIt is utmost important to make the right diagnosis for primary ovarian Burkitt\u0026rsquo;s lymphoma patients, since the rapid speed for BL invasion and metastasis. We could not find any patient who survived longer than the patient in this case among the past case reported. Chemotherapy with no delay in diagnosis and success in ASCT may help a lot.\u003c/p\u003e \u003cp\u003eIn this case, we could see that primary ovarian Burkitt\u0026rsquo;s lymphoma is highly mimicking ovarian cancer, and its diagnosis relies on pathological examination. Once diagnosed, further chemotherapy is needed. The primary pelvis mass will disappear as the chemotherapy went on. In conclusion, we could learn from this case that CA125 serum level elevation could happen to primary ovarian Burkitt\u0026rsquo;s lymphoma patients. The critical principal in treatment for primary ovarian Burkitt\u0026rsquo;s lymphoma patients could be no delay to undergo chemotherapy.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBurkitt lymphoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eASCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eautologous stem cell transplantation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePET-CT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePositron emission tomography-computed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCNS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecentral nervous system\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003enon-Hodgkin\u0026rsquo;s lymphoma\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLDH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elactate dehydrogenase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003euric acid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient who is the subject of this case report gave verbal consent to be involved in this case report. All authors of this original manuscript have read and approved the revised version of the paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial disclosure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that data in this study are available within this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBlum KA, Lozanski G, Byrd JC. Adult Burkitt leukemia and lymphoma. Blood 2004;104:3009\u0026ndash;3020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJaffe ES. The 2008 WHO classification of lymphomas: implications for clinical practice and translational research. Hematology Am Soc Hematol Educ Program 2009:523\u0026ndash;531.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMbulaiteye SM, Biggar RJ, Bhatia K, Linet MS, Devesa SS. Sporadic childhood Burkitt lymphoma incidence in the United States during 1992\u0026ndash;2005. Pediatr Blood Cancer 2009;53:366\u0026ndash;370.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatte C, Auperin A, Michon J, Behrendt H, Leverger G, Frappaz D, Lutz P, Coze C, Perel Y, Rapha\u0026euml;l M, Terrier-Lacombe MJ; Soci\u0026eacute;t\u0026eacute; Fran\u0026ccedil;aise d'Oncologie P\u0026eacute;diatrique. The Soci\u0026eacute;t\u0026eacute; Fran\u0026ccedil;aise d'Oncologie P\u0026eacute;diatrique LMB89 protocol: highly effective multiagent chemotherapy tailored to the tumor burden and initial response in 561 unselected children with B-cell lymphomas and L3 leukemia. Blood. 2001 Jun 1;97(11):3370-9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu H, Zhao C, Wang Q, Chen Y, Zhang W, Zhuang Y, Chen R, Zhang H. Primary ovarian Burkitt lymphoma: report of a case and review of literature. Int J Clin Exp Pathol. 2022 Mar 15;15(3):110\u0026ndash;119.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor JS, Frey MK, Fatemi D, Robinson S. Burkitt's lymphoma presenting as ovarian torsion. Am J Obstet Gynecol 2012;207:e4-6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStepniak A, Czuczwar P, Szkodziak P, Wozniakowska E, Wozniak S, Paszkowski T. Primary ovarian Burkitt's lymphoma: a rare oncological problem in gynaecology: a review of literature. Arch Gynecol Obstet 2017;296:653\u0026ndash;660.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllen GW, Forouzannia A, Bailey HH, Howard SP. Non-Hodgkin's lymphoma presenting as a pelvic mass with elevated CA-125. Gynecol Oncol 2004;94:811\u0026ndash;813.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026lt;oncolo_9_4_417.pdf\u0026gt;.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMay HP, Mara KC, Barreto EF, Leung N, Habermann TM. Relationship between uric acid and kidney function in adults at risk for tumor lysis syndrome. Leuk Lymphoma 2021;62:3152\u0026ndash;3159.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlderuccio JP, Olszewski AJ, Evens AM, Collins GP, Danilov AV, Bower M, Jagadeesh D, et al. HIV-associated Burkitt lymphoma: outcomes from a US-UK collaborative analysis. Blood Adv 2021;5:2852\u0026ndash;2862.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Burkitt’s lymphoma, ovarian cancer, ovary, lymphoma","lastPublishedDoi":"10.21203/rs.3.rs-1568279/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1568279/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBurkitt\u0026rsquo;s lymphoma (BL) in female adults is rare, the initial presentation of BL as an ovarian tumor is even rarer. A 30-year-old woman presented to the clinic with complaints of distention and went on exploratory laparotomy and pathological examination showed the final diagnosis as BL. Then the patient went on one year of seven cycles of chemotherapy and autologous stem cell transplantation (ASCT), the patient remained disease-free for six years and kept follow-up since then. This study offers the insights in how to make the right and rapid diagnosis and treatment recipe for primary ovarian Burkitt\u0026rsquo;s lymphoma patients.\u003c/p\u003e","manuscriptTitle":"Burkitt's lymphoma of the ovary","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-04-21 16:18:11","doi":"10.21203/rs.3.rs-1568279/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc9d428f-3a17-4ac9-bc81-c472f7121ef6","owner":[],"postedDate":"April 21st, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-04-21T16:18:13+00:00","versionOfRecord":[],"versionCreatedAt":"2022-04-21 16:18:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1568279","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1568279","identity":"rs-1568279","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}