Ovarian Tuberculosis masquerading as ovarian cancer in HIV infected patient: a plea to avoid unnecessary surgery

Abstract

Female patients who present with adnexial mass and weight loss should not be presumed to have ovarian carcinoma until after extensive investigation. This is to avoid the mistake of radical surgery with its attendant morbidity and mortality. An important disease to consider in our environment is ovarian TB that respond well to medication. A 35 year old HIV-1 positive house wife presented with fever, persistent vomiting, progressive weight loss, vague abdominal pain and swelling. Patient occasionally ingest unpasteurized milk since childhood but had no sustained contact with adult with chronic cough. She had no menstrual abnormality. Imaging studies revealed right ovarian mass measuring 11.8cmx10cm. Right ovarian malignancy was highly suspected, for which she underwent exploratory laporotomy. Histopathology result was consistent with tuberculous granuloma. Chest radiograph was normal. Her CD4 count was 541cells/ul. Patient was commenced on anti tuberculotic therapy based on the Nigerian National TB control and she responded well. Tuberculosis of the ovary can masquerade as ovarian cancer, especially among HIV patients in regions where TB-HIV co infections is endemic, it should be ruled out before performing extended surgery.

Ovarian Tuberculosis in a Developing Community

“…The above 31 years average is near to the 35 years of the fellow northern Nigerian [1]. Her illness was not due to HIV infection like the Northerner.…”

“…Recently, researchers based in Maiduguri, North Eastern Nigeria, reported a 35-year-old HIV-1 positive housewife, who turned out to have ovarian tuberculosis masquerading as ovarian cancer [1]. Therefore, the present report comes from the South Eastern part of the country with special reference to the ethnic group called the Ibo/Igbos [2].…”

Effect of Genital Tuberculosis on Ovarian Reserve

“…Difficulties in obtaining an adequate tissue biopsy from various affected areas without causing further damage to the female genital tract makes endometrial tissue the most widely used source for bacteriological diagnosis of FGTB 38,41. Concerns regarding invasive nature of ovarian biopsy with a tubo-ovarian mass in the absence of bacteriological or molecular confirmation, other causes of pelvic infection, endometriosis, and even ovarian malignancy should be considered and excluded [55][56][57][58][59][60]. Conversely, women with protracted, unexplained infertility may benefit from an active evaluation for FGTB.…”