Case Report Gynecol Obstet Invest 2001;52:71–72 Pelvic Tuberculosis Mimicking Signs of Abdominopelvic Malignancy S. Ozalp a O.T. Yalcin a H.M. Tanir a S. Kabukcuoglu b A. Akcay a Departments of a Obstetrics and Gynecology and b Pathology, Osmangazi University Faculty of Medicine, Eskis ¸ ehir, Turkey Received: December 5, 2000 Accepted: December 19, 2000 H. Mete Tanir, MD Department of Obstetrics and Gynecology Osmangazi University Faculty of Medicine, Mes ¸elik Kampüsü TR–26480 Eskis ¸ehir (Turkey) Tel./Fax +90 222 2398412, E-Mail mtanir@superonline.com ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2001 S. Karger AG, Basel 0378–7346/01/0521–0071$17.50/0 Accessible online at: www.karger.com/journals/goi Key Words Pelvic tuberculosis W Ascites W Ovarian Mass W Ca-125 Abstract We discuss the clinical presentation and consequences of pelvic tuberculosis in the context of 3 cases having developed typical signs and symptoms of ascites and abdominal mass. These cases are reported to emphasize the difficulty of early diagnosis and treatment of the dis- ease. Copyright © 2001 S. Karger AG, Basel Introduction Pelvioperitoneal tuberculosis, an uncommon gyneco- logic problem, is reported to usually occur following pri- mary pulmonary tuberculosis [1]. It is mostly confined to fallopian tubes, endometrium, ovary, and cervix. How- ever, it may simulate the signs of an abdominal mass such as ascites. In these instances, the definite clinical diagno- sis can hardly be made. This study reports 3 cases of pel- vic tuberculosis encountered within 1 year; on first admis- sion, investigation of the clinical signs and symptoms revealed an abdominal mass. Our aim is also to point out that gynecologists should be aware of this clinical entity to facilitate early diagnosis and treatment. Case Reports Case 1 A 68-year-old woman was hospitalized with complaints of ab- dominal pain, loss of appetite, and weight loss. Physical and pelvic examinations revealed a tense abdomen with ascites and a palpable, enlarged uterus. Her initial serum Ca-125 level was 244 mIU/ml. No tuberculin skin test was performed. Chest X-ray was reported to be normal. Gastrointestinal tract imagings showed no pathological find- ings. Paracentesis was initiated. Paracentesis fluid contained no malignant cells with lymphocyte predominance. Acid-fast staining and cell cultures revealed acid-fast bacilli. An explorative laparotomy was undergone during which 600 cm 3 ascitic fluid and omental and peritoneal adhesions and thickenings were observed. Analysis of fro- zen sections from the adhesions revealed a granulomatous reaction, suggesting tuberculosis. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed, and multiple biopsy speci- mens from the dense adhesions were obtained. The final histopatho- logical investigation confirmed the presence of caseous necrosis with Langhans’ cells and epithelial cells present in uterus serosa, intestinal serosa, ovaries, and peritoneum. Following her discharge, six courses of a triple-agent (isoniazid, rifampicin, ethambutol) antituberculosis regimen were initiated. After drug therapy, she was free from symp- toms, and the Ca-125 level dropped to 3.8 mIU/ml. Downloaded by: East Carolina University - Laupus Library 150.216.68.200 - 3/9/2019 3:09:23 AM