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Abdominopelvic tuberculosis mimicking malignant ovarian tumor
Amanda da Mota Silveira Rodrigues1, Alberto Carlos Moreno Zaconeta1, Maria de Fátima Brito Vogt1, Laura Cardoso Vasconcelos2
1Department of Obstetrics and gynecology, University Hospital of Brasília, Brasília, Brazil
2Department of Pathology, University Hospital of Brasília, Brasília, Brazil

Article ID: 100898Z01AR2018
doi: 10.5348/100898Z01AR2018CL

Corresponding Author:
Amanda da Mota Silveira Rodrigues,
Hospital Universitário de Brasília,
Departamento de Ginecologia e Obstetrícia,
SGAN 604/605 Av L2 norte-Asa Norte-Brasília-DF- Brazil, 70840-901

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How to cite this article
Rodrigues ADMS, Zaconeta ACM, Vogt MDFB, Vasconcelos LC. Abdominopelvic tuberculosis mimicking malignant ovarian tumor. Int J Case Rep Images 2018;9:100898Z01AR2018.


CASE REPORT

A 32-year-old woman was referred to the Gynecologic Oncology service with history of abdominal pain and weight loss of 10Kg in the last six months. An ultrasound performed a few days before had shown enlarged ovaries, ascites and omental and peritoneum thickening. CA125 level was 1986IU/mL (N<200IU/mL).

Considering the diagnosis of ovarian and peritoneal cancer, an exploratory laparotomy was performed. During surgery, there was no evidence of ovarian tumor, instead, diffuse nodules, edema and significant hyperemia were seen in the uterus, tubes, peritoneum and omentum (Figures 1 and 2). Intra-operative frozen section consultation showed a chronic granulomatous inflammatory process, with giant multinucleated cells. After tissue and peritoneal fluid samples collection, the abdomen was closed without any other intervention. Both, ascitic fluid Adenosine Deaminase levels and histopathological tissue analysis were suggestive of tuberculosis (Figure 3).

Staining methods searching for Alcohol and Acid Fast Bacilli and for fungi were negative (Figures 4 and 5). The patient was treated for tuberculosis with complete symptoms recovery.

Keywords: Ascites, Inflammatory disease, Ovarian cancer, Pelvic tuberculosis



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Figure 1: Nodules, edema and hyperemia of uterus and tubes.


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Figure 2: Diffuse nodules in omentum surface.


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Figure 3: Chronic granulomatous inflammatory process with Langhans type multinucleated giant cells, magnification 10X.


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Figure 4: Special staining (Fite-Faraco) negative for Alcohol and acid fast bacilli, magnification 40X.


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Figure 5: Special staining (Grocott) negative for fungi, magnification 40X.


DISCUSSION

The presentation of abdomino-pelvic tuberculosis simulating advanced ovarian cancer has been consistently reported in the literature [1], [2], [3], as the finding of pelvic masses, ascites and increased levels of CA 125 is common in both entities. Since the response to treatment and survival rates is totally different in the two conditions, differential diagnosis is especially important [3].

In women with echographic suspicion of an ovarian mass, a systematic analysis of signs indicative of malignancy has recently been proposed [4] and its use is expected to reduce false-positive results caused by inflammatory and infectious diseases, such as tuberculosis. When surgical intervention is necessary, the laparoscopic approach has advantages over open surgery and allows the obtaining of tissue and peritoneal fluid samples for analysis. In cases in which the diagnostic doubt arises during surgery, freezing biopsy is a priceless tool to avoid unnecessary bilateral oophorectomy.


CONCLUSION

Tuberculosis is an infectious disease with rare involvement of the genital tract, with the power to mimic other gynecological diseases, including malignant tumors. The diagnosis must combine a high index of suspicion with clinical evaluation and appropriate histopathological and microbiological investigation. If this diagnosis is suspected, it can spare patients from unnecessary surgeries.


REFERENCES
  1. Xi X, Shuang L, Dan W, et al. Diagnostic dilemma of abdominopelvic tuberculosis: A series of 20 cases. J Cancer Res Clin Oncol 2010 Dec;136(12):1839–44.   [CrossRef]   [PubMed]    Back to citation no. 1
  2. Koc S, Beydilli G, Tulunay G, et al. Peritoneal tuberculosis mimicking advanced ovarian cancer: A retrospective review of 22 cases. Gynecol Oncol 2006 Nov;103(2):565–9.   [CrossRef]   [PubMed]    Back to citation no. 2
  3. Liu Q, Zhang Q, Guan Q, Xu JF, Shi QL. Abdominopelvic tuberculosis mimicking advanced ovarian cancer and pelvic inflammatory disease: A series of 28 female cases. Arch Gynecol Obstet 2014 Mar;289(3):623–9.   [CrossRef]   [PubMed]    Back to citation no. 3
  4. Timmerman D, Van Calster B, Testa A, et al. Predicting the risk of malignancy in adnexal masses based on the simple rules from the international ovarian tumor analysis group. Am J Obstet Gynecol 2016 Apr;214(4):424–37.   [CrossRef]   [PubMed]    Back to citation no. 4

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Author Contributions
Amanda da Mota Silveira Rodrigues – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Alberto Carlos Moreno Zaconeta – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Maria de Fátima Brito Vogt – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Laura Cardoso Vasconcelos – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Consent Statement
Written informed consent was obtained from the patient for publication of this study.
Conflict of Interest
Author declares no conflict of interest.
Copyright
© 2018 Amanda da Mota Silveira Rodrigues et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.