Introduction/Background A 54-year-old patient with no preexisting comorbidities presented in our clinic with dyspnea and abdominal distension. The clinical examination revealed pleural effusion and ascites. Gynecological sonography showed an ovarian cyst (54x44 mm), ascites and peritoneal carcinosis in the pouch of Douglas, suspicious of ovarian cancer, as well as a suspicious lymph node in the right axilla. In order to confirm the diagnosis of ovarian cancer and to schedule further therapeutic steps, a staging laparoscopy was performed. Intraoperatively white milky ascites, white stipple bedding on the diaphragm and liver as well as white-yellow marbling of the liver were detected. The fallopian tubes and the ovaries were enlarged with tumor. Biopsies were taken from the diaphragm, the liver around the falciform ligament and from the right fimbrial funnel. All biopsies from the abdomen and the axilla revealed high lymphatic infiltration matching a stage III B-cell-lymphoma (marginal zone lymphoma). The patient was transferred to the hemato-oncological department for further therapy. Cytostatic therapy with six cycles R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine sulfate, prednisone) was initiated and the patient is doing well and shows no signs of recurrence 6 months after completion of cytotoxic therapy.

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Conclusion This case report presents a rare case of manifestation of an extra nodal B-cell-lymphoma with abdominal presentation, mimicking ovarian cancer. Staging laparoscopy and biopsy were crucial steps in order to confirm the diagnosis. Interdisciplinary cooperation is crucial for a fast and adequate induction of the appropriate therapy.

Disclosures -