Tubercular tubo-ovarian cystic mass mimicking acute appendicitis: a case report

Abstract

Introduction: Female genital tuberculosis is a rare form of extrapulmonary tuberculosis. It is an asymptomatic disease usually diagnosed during the search for causes of infertility. However, it can present with a number of abdominopelvic symptoms. Herein we report a case of tubo-ovarian tuberculosis mimicking acute appendicitis.

Case presentation: A 17-year-old single Turkish woman presented to our hospital with complaints of right lower quadrant abdominal pain, nausea, and vomiting. Her physical examination findings, ultrasonogram, and leukocyte count were consistent with acute appendicitis. A cystic mass (15 cm × 6 cm) was detected on the right tubo-ovarian structure by laparotomy. The mass was excised while the tubo-ovarian structures were preserved and the need for an appendectomy was avoided. No microbiological evaluation was performed. The histopathological examination of the cystic mass revealed a granuloma with central caseating necrosis surrounded by epithelioid histiocytes. The patient was treated with anti-tuberculosis therapy for six months. No recurrence was observed during a 10-month follow-up period.

Conclusion: Genital tuberculosis should be considered in the differential diagnosis of right lower quadrant pain in women who live in tuberculosis-endemic regions.

Figure 1

A cystic mass, 15 cm × 6 cm in size, in an exophytic location and originating from the right tubo-ovarian complex (arrow).

Figure 2

Epithelioid granulomas (arrow) with central necrosis, surrounding epithelioid cells, some lymphocytes, and fibrosis at the periphery (original magnification, × 200).

Figure 3

Granulomatous inflammation process with central necrosis, epithelioid cells and lymphocyte halo at the periphery (white arrow). Scattered giant cells are present in the granuloma (yellow arrow) (original magnification, × 100).