Ovarian Tuberculosis Mimicking Ovarian Malignancy: A Diagnostic Challenge in an Endemic Setting

TL;DR

This paper presents a case where ovarian tuberculosis was mistaken for ovarian cancer, highlighting the diagnostic challenges in regions where tuberculosis is common.

Contribution

The case emphasizes the need to consider tuberculosis in the differential diagnosis of adnexal masses with elevated CA-125 in endemic areas.

Findings

Ovarian tuberculosis can mimic advanced ovarian carcinoma with similar clinical and radiological features.

Histopathological confirmation is crucial to avoid misdiagnosis and unnecessary chemotherapy.

The patient showed improvement with anti-tuberculous therapy after correct diagnosis.

Abstract

Ovarian tuberculosis is a rare manifestation of extrapulmonary tuberculosis and may closely resemble advanced ovarian carcinoma due to overlapping clinical, biochemical, and radiological features. We report the case of an 18-year-old female who presented with progressive abdominal distension, severe hypogastric pain, and unintentional weight loss. Imaging revealed a left adnexal mass with ascites and retroperitoneal lymphadenopathy suggestive of stage IIIC ovarian carcinoma. Serum CA-125 was markedly elevated (637.4 U/mL). Prior to initiation of chemotherapy, an image-guided TRUCUT biopsy demonstrated chronic granulomatous inflammation with acid-fast bacilli. Ziehl-Neelsen staining was positive, QuantiFERON-TB Gold assay was positive, and culture of the adnexal lesion confirmed Mycobacterium tuberculosis. The patient was treated with first-line anti-tuberculous therapy and showed clinical and radiological improvement. This case highlights the importance of considering tuberculosis in the differential diagnosis of adnexal masses with elevated CA-125, particularly in endemic regions, and emphasizes the value of histopathological confirmation to prevent misdiagnosis and avoid unnecessary oncologic treatment.

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