Ovarian Lymphoma and Bone Metastasis Presenting With Paraparesis in an Adolescent: A Case Report

BACKGROUND Lymphoma comprises a heterogeneous group of lymphoid malignancies broadly categorized as Hodgkin lymphoma and non-Hodgkin lymphoma. Ovarian involvement is exceedingly rare, particularly in adolescents, and is most commonly associated with diffuse large B-cell lymphoma (DLBCL) as part of systemic disease. Its clinical and radiological resemblance to primary ovarian malignancies often leads to diagnostic challenges. CASE REPORT We describe the case of a 17-year-old nulligravid female adolescent who presented with a 2-month history of progressive bilateral lower extremity weakness accompanied by lower abdominal pain. Radiological evaluation revealed large bilateral ovarian masses with extensive pelvic organ infiltration, vertebral metastases, epidural extension causing spinal cord compression, and pleural effusion. The patient underwent exploratory laparotomy with suboptimal tumor debulking. Histopathological examination, supported by immunohistochemical analysis, demonstrated diffuse cluster of differentiation (CD)20 positivity, CD3 negativity, and a high Ki-67 proliferation index (approximately 80%), consistent with high-grade DLBCL. Despite postoperative supportive care and planned initiation of systemic chemotherapy, the patient's condition rapidly deteriorated, resulting in death within 3 months of symptom onset. CONCLUSIONS Ovarian involvement by DLBCL in adolescents is a rare and highly aggressive clinical entity that can closely mimic advanced epithelial ovarian malignancy. The presence of atypical features, including neurological deficits secondary to spinal involvement, may further complicate diagnosis. Definitive diagnosis relies on histopathological and immunohistochemical confirmation. Early recognition and timely initiation of systemic therapy are essential; however, prognosis remains poor in cases with advanced dissemination.