Abdominal distention in a pediatric patient

A 7 year old female presents complaining of abdominal distention 


A 7 year old female presents to clinic in Tanzania complaining of abdominal distention, fatigue, difficulty ambulating and shortness of breath with exertion over the past three months. Her abdominal exam is significant for a soft but markedly distended abdomen with diffuse tenderness. A large palpable mass was noted. An ultrasound was performed of her abdomen. 


What is noted in ultrasound image 1?

Ascites and a large 12cmx20cm homogenous mass is noted in the right upper quadrant, likely originating from the ovaries. 

What is this finding concerning for?

Burkitt's lymphoma. The patient was presumed to have Burkitt's lymphoma due to its prevalence associated with Ebstein Barr virus (EBV) and HIV among the pediatric population in Tanzania. The incidence of Burkitt's lymphoma has risen dramatically over the past few years in endemic areas due to increased prevalence of EBV and HIV. It is the most rapidly growing tumor in children, doubling in size every 22 hours. The median age of children affected is 8 years. Differential diagnosis includes, but is not limited to, neuroblastoma, Wilm's tumor, hepatoblastoma, sarcoma, lymphoma, abscess and teratoma.