A 16 years old female was referred from district hospital. Her main complaints were abdominal pain and enlargement for the last 2 months. The suspicion of malignant ovarian cyst was established from referring obstetrician based on abdominal ultrasound. Defecation and micturition pattern were normal.
Her menstrual cycle was normal, with 28-30 days' cycle and 4-5 days of menstrual period in each cycle. There was no history of fever, vaginal discharge, chronic illness, chronic cough, and significant weight loss. There was no obvious contact with person with tuberculosis or those in tuberculosis therapy.
A thorough physical examination revealed slightly distended abdomen, with palpable cystic mass up to 2 cm above pubic symphysis. From bimanual palpation, uterus was palpable within normal size, with palpable cystic mass in left adnexa.
Abdominal ultrasound showed a cystic mass in left adnexa, measured 43 x 37 mm, with solid parts and irregular border, along with peritoneal free fluid. Abdominal computed tomography (CT) scan further showed a complex left ovarian cyst with ascites, suggesting malignant appearance. CT also founded right renal pelviectasis, hepatosplenomegaly, and bilateral inguinal lymphadenopathy.
Laboratory workup for tumor biomarker was performed, with result supporting the suspicion of malignancy process (CA-125: 886 U/mL).
Exploratory laparotomy was performed to found the fragile, solid mass which filled most of abdominal cavity and adhered to the pelvic wall, a condition commonly known as 'frozen pelvis', causing further exploration without making massive tissue destruction was impossible. Operator decision was to close the abdomen after collecting some tissue for histopathology workup.
Histopathology report came out a week later, revealing a granulomatous inflammation related to tuberculosis process (Fig. 1). The diagnosis of abdominal tuberculosis was subsequently established.