گزارش يك مورد توده لگني همراه با آسيت و افزايش سطح سرمي CA-521 در پريتونيت ميلياري سل

Pelvic mass with ascitis and eleveted serum CA- 125 level in miliert tuberculer peritonitis

Background and purpose : Pelvic mass with ascitis and elevated serum CA-125 level is suggestive of an advanced ovarian malignancy. Peritonitis is an uncommon event. Which can have the same symptoms, therefore this phenomenon must be considered in case of differential diagnosis of ovarian carcinoma. Aim of reporting this interesting and rare case, is to make attention of colleages to this differential diagnosis prior to and during operation. Case report : The case was a 28 years old female with ascitis and elevated serum CA-125 level of more than 500 units per ml. Pelvic mass was reported in sonography and CT-scan, and underwent laparatomy with probable diagnosis of advanced ovarian carcinoma. Frozen sections showed multiple necrotized caseous granulomatous lesions, highly suggestive of tuberculosis. Following treatment of tuberculosis, Serum CA-125 level declined to normal range(less than 35 units per ml) and ascitis was disappeared. Conclusion : Peritoneal tuberculosis can have the exact symptoms of advanced ovarian tumor during surgery. Peritoneal tuberculosis may be mistakan with advanced ovarian cancer or primary peritoneal carcinoma. Hence, during operation, particularly in young females, operation must be performed after being sure about the malignancy, So, not to deprive the patient from ovarian endocrinal activity. This issue is more prevalent, paticulary in the developing countries which must be considered.