Research Article: Isolated Ovarian Tuberculosis Mimicking Ovarian Carcinoma: Case Report and Literature Review

Date Published: , 2011

Publisher: African Ethnomedicines Network

Author(s): SSEN Rabesalama, KL Mandeville, RA Raherison, HN Rakoto-Ratsimba.

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Abstract

Although genitourinary tuberculosis is common, reports of isolated ovarian tuberculosis are rare. However, its presentation can mimick that of an ovarian tumour, leading to diagnostic difficulties. A woman of 17 years presented with chronic pelvic pain, weight loss, a right ovarian mass on ultrasound, and a significantly elevated CA-125 level. A diagnosis of ovarian carcinoma was made, and laparotomy was performed with resection of the right ovary. Postoperative histological examination, however, revealed classic tuberculoid appearances, with no signs of malignancy. Antituberculosis treatment was commenced, with full resolution of her symptoms and a decrease in CA-125 level. Isolated ovarian tuberculosis is most common in young women living in endemic zones. CA-125 can be raised in both conditions, and imaging is rarely conclusive. Intraoperative frozen section of tissue specimens can be helpful if available. Early diagnosis of ovarian tuberculosis is vital as untreated disease can lead to infertility.

Partial Text

Tuberculosis (TB) remains a significant public health problem worldwide. There were an estimated 9.2 million new cases and 1.7 million deaths from TB in 2008 (Global Tuberculosis Control Report 2008). Although genito-urinary disease is common, isolated ovarian TB is rare (Nebhani et al, 2004). We report here a case in a young girl treated in Antananarivo, Madagascar. The clinical features and diagnosis of ovarian TB are discussed, with a review of the literature.

A nulliparous woman, aged 17 years, presented to hospital with a 2 month-history of pelvic pain. This was associated with a low-grade fever, weakness, and anorexia. She also reported a weight loss of 4kg in 6 months, with a BMI of just 15. She had received the Bacille Calmette-Guerin (BCG) vaccination at birth and there was no history of contact with tuberculosis.

Genito-urinary tuberculosis is the second most frequent location for extra-pulmonary tuberculosis, after the lymphatic system (Watfa and Michel, 2005). This site can represent up to 19% of gynaecological admissions in some developing countries (Sfar et al, 1990). The endometrium and fallopian tubes are almost always affected by the disease (Agarwal and Gupta, 1993). The ovaries were involved in 62.5% of cases in one study (Agarwal and Gupta, 1993). However, isolated ovarian TB with no other organ involvement as in this case, is rarely reported in the literature.

Isolated ovarian tuberculosis is rare. Its presentation can mimic that of an ovarian malignancy, including an ovarian mass, ascites and a rise in CA-125 level. It should be kept in mind as a differential diagnosis, both in developing and developed countries.

 

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