A 24-year-old woman presented to our Pelvic Mass Ambulatory Unit (Federal University of the Triangulo Mineiro (UFTM)) with a history of abdominal pain for the previous week that was associated with weight loss, fever, diarrhea, nausea, and ascites. A chest X-ray was normal. Abdominal ultrasonography showed an enlarged right ovary (3.2 x 4.0 x 4.0 cm; volume, 27.6 ml), with heterogeneous echogenicity, cystic areas, and thick walls. Magnetic resonance imaging (MRI) showed a heterogeneous mass with well-defined edges involving the right ovary that measured approximately 5.0 cm in diameter and exhibited heterogeneous contrast enhancement. The left ovary and uterus were normal. Additional observations included enlarged iliac lymph nodes, smaller lesions in the posterior fornix, abdominal ascites, and diffuse enhancement of the peritoneum. CA-125 and CA-15.3 levels were also increased (201 U/mL and 40.2 U/ml, resp.).
An exploratory laparotomy was performed. The pelvis was frozen and the entire bowel and omentum were congested, similar to peritoneal carcinomatosis. During the procedure, biopsies were performed of the pelvic peritoneum, the fallopian tube, and the right ovary. An ascite sample was also collected. An intraoperative frozen section analysis detected atypical cells that were suggestive of ovarian borderline or malignant epithelial neoplasia (Figure 1). Despite these results, conservative surgery was performed based on the patient's desire to maintain her ability to become pregnant.
The pathological analysis showed granulomatous inflammation in the right ovary and fallopian tube with a pattern of mycobacteriosis that was consistent with the presence of mycobacteria morphologically compatible with Mycobacterium tuberculosis.
The patient was referred to the Infectious Diseases Service and received antituberculosis drugs. Six months later, the patient reported overall good health. Her CA-125 levels and an abdominopelvic ultrasound were both normal. Upon completion of the tuberculosis treatment, the patient was trying to become pregnant.