case_images: PMC9969431_01
case_images: Left adnexal mass measuring about 4 x 4.2 cm on computed tomography of the
  abdomen and pelvis.
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case_images: Computed tomography of the abdomen done showed fatty liver, hepatomegaly, and a left heterogeneous ovarian mass measuring 4 x 4.2 cm (Figure 1) and an enlarged left adrenal gland measuring 1.5 x 2 cm.
case_images: Hematoxylin & eosin-stained section of the ovarian mass showing a diffuse
  proliferation of large somewhat pleomorphic cells. Photographed at 20x
  magnification.
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case_images: Her pathology showed that the left ovary displayed near-complete replacement by a diffuse proliferation of large somewhat pleomorphic cells (Figure 2), with prominent nucleoli (Figure 3), numerous mitotic figures, admixed body macrophages, and punctate areas of necrosis.
case_images: Hematoxylin & eosin-stained section of the ovarian mass photographed at
  40x magnification showing the irregular nuclear contours and prominent
  nucleoli.
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case_images: Her pathology showed that the left ovary displayed near-complete replacement by a diffuse proliferation of large somewhat pleomorphic cells (Figure 2), with prominent nucleoli (Figure 3), numerous mitotic figures, admixed body macrophages, and punctate areas of necrosis.
case_images: Ovarian mass photographed at 20x magnification stained with Ki-67
  immunohistochemistry showing the high proliferation index with >90% of
  the cells staining positive (brown = positive).
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case_images: Immunohistochemistry showed the malignant cells expressed PAX5, CD20, MYC (Figure 4), and BCL2 (weak 30%).
case_images: Ovarian mass photographed at 20x magnification stained with MYC
  immunohistochemistry showing expression in about 50% of the cells (brown =
  positive).
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case_images: Her Ki-67 proliferation index was greater than 90% (Figure 5).