Female genital tract tuberculosis presenting as ovarian cancer
A 20-year-old primiparous woman with abdominal and pelvic pain was referred to the department of gynecology at Ghaem University Hospital, Mashhad, Iran in July 2000.\nShe complained of anorexia, nausea, vomiting and urinary symptoms (dysuria and frequency) since few weeks before presentation. She had lost about four kilograms of weight since two months ago and she had a history of fever since the previous week. She had no personal or family history of TB. Upon examination, her vital signs were normal and she had no remarkable physical finding, except for a firm, fixed and tender mass in the right adnexa. Otherwise, the abdominal examination was normal and the patient had no ascites. An ultrasound study showed a 13 × 6 cm, multi-septated, mixed echogenic mass in the right adnexa and mild free fluid suggestive of a malignant process. Her biochemical profile and complete blood counts were in the normal range. There was no abnormality in chest X-ray, and her tuberculin skin test (TST) was negative.\nBased on her clinical and imaging findings which suggestive of ovarian cancer, a diagnostic laparotomy was planned. The operation revealed dense adhesions between pelvic organs, and multiple biopsies were performed. Finally, histopathological investigation revealed necrotizing granulomatous changes consistent with TB with no malignant cells.