Abstract :

Background: Tuberculosis continues to be endemic in developing countries. Despite genitourinary tuberculosis being common, reports of isolated ovarian tuberculosis are rare, further its presentation can mimic that of ovarian cancer. Challenge arises when evaluating patients who lack usual clinical symptoms and laboratory evidence required for correct diagnosis.

Case Presentation: A 19-year-old female presented to our facility with a history of undergoing exploratory laparotomy 3-months prior at rural district hospital due to a pelvic mass and no biopsy was taken. Laboratory examination revealed an increase in cancer antigen (CA125) and normal serum beta-Human Chorionic Gonadotropin (HCG) and Alpha Fetal Protein (AFP) levels. Both pelvic ultrasound and Magnetic Resonance Imaging (MRI) yielded inconclusive results. As a result, the decision for re-laparotomy was made due to presumptive diagnosis of ovarian tumor. Surgical excision of a solid ovarian mass was done during surgery and histopathological examination later revealed presence of ovarian tuberculosis. Thereafter, anti-TB drugs were started and worked well, as shown by the disappearance of symptoms, and the return of CA 125 levels to normal.

Conclusion: High index of suspicion is needed by clinicians dealing with cases of ovarian mass with atypical clinical, laboratory and radiological findings and should weigh the benefits of ultrasound-guided biopsy against risks of invasive surgery.