Miss AH was an 18-year old unmarried school leaver who had a four-week history of progressive abdominal pain and lower abdominal swelling. Pain was insidious, dull in character and was worse over a lower abdominal swelling that was noticed about the same time. There was no cough, nor history of contact with someone with chronic cough. There was occasional difficulty with breathing. There was no fever or drenching night sweats. There was weight loss which was attributed to anorexia, early satiety with occasional vomiting of recently ingested meals. There was no swelling in any part of her body. There was no change in bowel habit or lower urinary tract symptoms. Other systems reviewed were essentially normal. Lately menses had been irregular. She was not sexually active and not sure of date of her last menstrual flow. Family and social and drug history were not significant. 
At presentation she was chronically ill, in painful distress, afebrile, not pale, anicteric, and she had no significant peripheral lymphadenopathy and no peripheral oedema. Vital signs were within normal limit and chest was clinically clear. There was a tender suprapubic mass about 22 weeks gestational size that was slightly mobile transversely. Bowel sounds were normal. The hymen was intact. Digital rectal examination revealed a normal rectal mucosa with a bulging pouch of Douglas but no Blummer's shelves. 
A provisional diagnosis of intra-abdominal malignancy of probable ovarian origin was made. 
Full blood count was normal with relative lymphocytosis (54%). Serum electrolytes and urea were within normal limits. Abdominal ultrasonography suggested intra abdominal masses of probable ovarian origin. Computerized tomography scan and laparoscopy were considered but not done because the services were not available and patient could not afford them in centres where they are available. She was HIV I and II negative on the determine kit. She had exploratory laparotomy. Intra-op findings were of copious milky blood-stained intra peritoneal collection, bilateral ovarian masses with induration of tubes, broad ligaments, and the greater omentum. The diaphragm, liver, splenic surfaces and guts were grossly normal. A left salpingoophorectomy and wedge biopsy of the omentum and right ovary were done. These specimens (Figure 1) were sent for histology while the ascetic fluid was tested for acid/alcohol fast bacilli (AAFB) test. The AAFB test was negative. She had empirical treatment for disseminated tuberculosis with rifampicin, isoniazide, ethambutol, and pyrazinamide. On the14th day after operation she had an underwater seal-closed right thoracostomy tube drain for massive chylothorax. Histology of the surgical specimens indicated Burkitt's lymphoma (Figures 1, 2, and 3). The peripheral blood film showed normal white cell count with relative lymphocytosis, and bone marrow biopsy was not indicative of involvement. The anti-Koch's therapy was discontinued. She had two courses of combination therapy with cyclophosphamide, vincristine, and methotrexate. Response was remarkable after the first course, but patient died after the second course of therapy probably from tumour lysis syndrome or chemotoxicity; despite the use of allopurinol prophylaxis. post-mortem study to ascertain cause of death was advised but the deceased family declined the study.