Ovarian mass - tuberculosis or malignancy? Need for early intensified evaluation

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EXCLI Journal

Letter to the Editor

Dear Editor,

We read with interest the case report by Chien et al. on Peritoneal Tuberculosis (TB) mimicking ovarian cancer (Chien et al., 2016[1]). We want to congratulate the authors on this case report.

We encountered a similar case in our clinical setting in western India. A 30-year old woman presented with intermittent fever, abdominal pain, abdominal distension and weight loss for three months. The clinical examination showed doughy feel of the abdomen and the pelvic exam showed bilateral adnexal masses. The ultrasonography showed bilateral solid cystic ovarian masses. Further, the computed tomography of abdomen and pelvis showed ascites, ovarian masses with peritoneal deposits. With these findings, the differential diagnosis of TB and ovarian cancer was considered. Laboratory investigations revealed elevated CA-125 levels (1083 U/ml). But the other tumor markers such as Alfa Fetoprotein, Lactate Dehydrogenase, Carcinoembryonic Antigen, β Human Chorionic Gonadotropin were found to be negative. Ascitic tap revealed positive Acid Fast Bacilli (AFB) and elevated ADA levels (54.4 IU/ml) that confirmed the TB diagnosis (Riqueime et al., 2006[2]). Anti-tuberculosis treatment was initiated and dramatic resolution of masses was observed on clinical examination as well as ultrasound, and CA-125 decreased to normal levels at 3 months and weight gain of over ten kilograms was seen at 6 months of TB treatment.

Naik S, Owal S. Ovarian mass - tuberculosis or malignancy? Need for early intensified evaluation. EXCLI Journal. 2018 Sep 14;17:914-915. PMID: 30564070 PMCID: PMC6295639.