Pelvic Tuberculosis Masses Mimicking Advanced Ovarian Cancer: Case Report And Literature Review

Background: Tuberculosis (TB) is seldom thought of as a differential diagnosis although being the leading cause of death from infectious disease worldwide. It is estimated that abdominal TB (in the gastrointestinal tract, peritoneum, lymph nodes, or solid viscera) accounts for 1%-15% of extrapulmonary TB and for 1%-3% of all TB cases, being confused with carcinomatosis.Case: A 17-year-old female patient was transferred to the current authors' hospital due to fever, abdominal pain, ascites, and a previous laparoscopy showing carcinomatosis and ovarian lesions. Her serum cancer antigen-125 was 1529.8 U/mL and her lactate dehydrogenase was 2353 U/mL. Abdominal magnetic resonance imaging showed lesions with expansive aspects in the adnexal regions, suggesting a neoplastic process. Thoracic computed tomography was suggestive of an active granulomatous infectious process. Her previous laparoscopic biopsy was reexamined, showing active chronic salpingitis with necrotic granulomas and an absence of acid-fast bacilli. Laparoscopy with peritoneal biopsies was performed.Results: Pathology analysis of the newer specimens did show acid-fast bacilli, compatible with mycobacteriosis. This latter culture examination was compatible withMycobacterium tuberculosis. She was treated with rifampin, isoniazid, pyrazinamide, and ethambutol for 2 months, followed by 4 months of maintenance treatment with rifampin and isoniazid. At 8 months after the end of treatment, she was asymptomatic.Conclusions: Tuberculosis should be considered as a differential diagnosis of ovarian cancer, especially in endemic areas. Imaging findings can be misdiagnosed as advanced ovarian malignancy, pelvic inflammatory disease, and other pathologies, being that peritoneal biopsy with pathologic examination is the only method to exclude malignant disease. Diagnosing this can be difficult but the importance of differential diagnoses for malignant conditions is important to avoid unnecessary extensive surgery.