A 16 years old female was referred from a private local hospital with suspected ovarian malignancy. She reported painful abdominal enlargement since the last year along with nausea and vomiting and marked weight loss. No history of fever, chronic cough, nor contact with tuberculosis-positive persons. Previous ultrasound examination showed ovarian mass with malignant appearance.
She appeared cachexic, with body mass index only 15.8 kg/m2. Abdominal palpation revealed a lower abdominal mass originating from pelvic cavity up to umbilical level. Abdominal ultrasound showed large multilocular abdominal mass filling the pelvic cavity. No ascites fluid was found. Unfortunately, abdominal CT scan was not performed for this patient. Tumor marker was checked and CA-125 was found high (481 U/ml).
She was diagnosed with suspected ovarian malignancy and laparotomy was planned. During surgery, parietal peritoneum was found thick and easily bleed. After it was opened, massive adhesion of abdominal organ was found and further exploration was considered impossible without damaging surrounding organs. Surgery was completed after collecting peritoneal tissue to be sent to pathology laboratory.
Histopathological result showed granulomatous inflammation specific for tuberculous infection. The patient then was sent to internal department to receive extrapulmonary tuberculosis drug regimen.