A 57-year-old married woman, Gravida 9, Para 8, consulted with the gynecologic ward by gasteroentrology consultant and then admitted complaining abdominal pain and distension since last two months (Figure 3). She lost 10 kg during these 2 months which is highly suggestive of a serious problem. Her past medical and gynecologic history was unremarkable. Family history was negative. In physical examination she was pale. Abdomen was distended with tenderness in the palpation of the periumbilical and hypogastric areas. Hemoglobin was 9.4 mg/dL. Serum tumor markers were normal except CA-125 >1000 u/mL. Chest X-ray was normal. Ultrasonography showed normal liver, spleen, kidneys, and uterus, but showed cystic masses in both adnexa with septation in favour of malignancy. Computerized tomography showed ascites. No sign of metastasis. So laparatomy with midline incision was done with impression of ovarian malignancy.
About one liter ascites aspirated and omental cake with miliary seeding, which were seen all over the peritoneum and pelvic organs and over the liver and spleen, has been biopsied. Ovarian masses were removed and sent for frozen sections along with the other biopsied specimens with the result of granulomatosis. Because of necrotic and hemorrhagic appearance of uterus and ovaries as well as the patient's age and condition total abdominal hysterectomy and bilateral salpingooophorectomy were done to prevent postoperation complications. Result of permanent pathology was fibrotic right oviduct with granulomatous inflammation. Right ovary with granulomatous inflammation in favour of TB ascitic fluid cytology showed inflammatory cells. Patient was discharged with antituberculosis drugs.
All three cases were in very good status in 6 months followup with normal pelvic exam, normal pelvic ultrasonography and CA125 measurement.