Ascites and adnexal masses: not always ovarian or tubal carcinoma

Description

A 32-year-old Mozambican woman presented to the hospital with progressive abdominal distension, pelvic pain and low-grade fever (38°C). Her family history was significant for one sister with breast cancer at the age of 40 years. In the diagnostic assessment, cancer antigen 125 (CA-125) was highly elevated (950 U/L) and the pelvic MRI showed bilateral tubal enlargement, right suspicious ovarian cyst and diffuse mesenteric thickening, A diagnosis of ovarian/tubal carcinoma with peritoneal carcinomatosis was suspected. Diagnostic laparoscopy revealed high volume ascites, bilateral tubal enlargement and peritoneal oedema, as well as multiple whitish nodules affecting uterine, adnexal and intestinal serosas and omentum thickening (video 1, figure 1), suggestive of peritoneal tuberculosis. Visual diagnosis during laparoscopy can be diagnostic in up to 95% of cases of this disease,1 but in developed countries where tuberculosis is no longer an endemic disease, these laparoscopic findings are no longer...

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