Female genital tract tuberculosis presenting as ovarian cancer
A 20-year-old virgin girl was referred to the department of gynecology at Ghaem University Hospital, in May 2005. She complained of abdominal pain and distention, as well as ten kilograms weight loss since 4 months ago. Before admission, she received multiple courses of antibiotic therapy, regarding her complaints of fever, sweat and cough.\nShe had hypomenorrhea. Her past medical history and family history of TB were negative. Physical examination revealed ascites without any palpable masses. Ultrasound study revealed a 48 × 54 cm cystic mass with internal echogenicity in the left adnexa and massive ascetic fluid. Laboratory tests showed leucopenia (WBC = 3.2 × 109 l−1) and no anemia (Hgb = 132 gl−l). The CA-125 level was elevated to 44 units per ml (normal range: 0-35 units per ml). Cytopathological study of the ascetic fluid showed no malignant cells. The acid fast staining of the ascetic fluid was also negative. Her chest X-ray and tuberculin skin test were normal. Regarding the clinical findings, an exploratory laparotomy was performed which showed abundant amount of intense adhesions between omentum, transverse colon, abdominal wall and pelvic organs. Transverse colon was ruptured due to severe adhesions and therefore got repaired and some biopsies were taken. Histological examination confirmed necrotizing granulomatous inflammation consistent with tuberculosis []. Hence, the standard anti-tuberculosis treatment was prescribed. At follow-up 2 years after the last visit, she reported that all of her previous symptoms were resolved.