Ascites and Adnexal Mass with Raised CA125: How Arduous can be the Path of Diagnosis

  • Deepika Pannu Department of Obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi,India.
  • Sunita Malik Department of obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi,India.
  • Saritha Shamsunder Department of obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi,India.
  • Amar Bhatnagar Department of obstetrics and Gynecology, VMMC and Safdarjung Hospital, New Delhi,India.
Keywords: Adenosine Deaminase; Ovarian carcinoma; Pelvic tuberculosis.

Abstract

Ascites, adnexal mass and elevated CA125 levels almost always suggest advanced ovarian carcinoma. We present a case of a 37 years old multiparous lady who presented with such a classical picture. Radiological picture was suggestive of ovarian carcinoma with peritoneal metastasis. However ascitic fluid cytology was negative for malignant cells. A differential diagnosis of tubercular mass was made. Ascitic fluid was sent for adenosine deaminase test that was negative. Fine needle aspiration cytology failed to reveal any sufficient sample for evaluation. Open laparotomy and biopsy was done that showed granulomas suggestive of tuberculosis. Category one anti tubercular treatment was started and symptoms resolved within one month. 
Keywords: Adenosine Deaminase; Ovarian carcinoma; Pelvic tuberculosis. | PubMed

References

Shen-Gunther J, Mannel RS. Ascites as a predictor of ovarian
malignancy Gynecol Oncol. 2002 Oct;87(1):77-83.
2. Soper JT, Hunter VJ, Daly L. Preoperative serum
tumorassociated antigen levels in women with pelvic masses.
Obstet Gynecol. 1990;75:249-54.
3. Sugiyama A, Urushihara N, Fukumoto K et al. Ovarian
fibroma with marked ascites and elevated serum levels of
CA-125 in a young girl. J Pediatr Surg. 2011 May;46(5):1001-4.
4. Ying Wang, Feng Zhou, Jia-Le Qin et al. Pregnancy luteoma
followed with massive ascites and elevated CA125 after
ovulation induction therapy: a case report and review of
literatures. Int J Clin Exp Med. 2015; 8(1): 1491–1493.
5. D K O'Riordan, A Deery, A Dorman, 0 E Epstein. Increased
CA 125 in a patient with tuberculous peritonitis: case report
and review of published works. Gut. 1995; 36: 303-305.
6. F. M. Sanai and K. I. Bzeizi, “Systematic review: tuberculous
peritonitis—presenting features, diagnostic strategies and
treatment,” Alimentary Pharmacology and Therapeutics.
Vol. 22, no. 8, pp. 685–700, 2005.
7. Yi-Jun Liao, Chun-Ying Wu, Shou-Wu Lee, Chia-Ling
Lee, Sheng-Shun Yang, Chi-Sen Chang et al. Adenosine
deaminase activity in tuberculous peritonitis among patients
with underlying liver cirrhosis. World J Gastroenterol. 2012
Oct 7; 18(37): 5260–5265.
Diagnostic value of Adenosine Deaminase (ADA) activity in
tubercular serositis. Indian J Tuberc. 2006; 53:92-95.
9. I. Lataifeh , I. Matalka, W. Hayajneh, B. Obeidat, H. Al Zou
’ bi & G. Abdeen. Disseminated peritoneal tuberculosis
mimicking advanced ovarian cancer. Journal of Obstetrics
and Gynaecology. 2014; Early Online: 1–4.
10. Primary Surgery: Volume One: Non-trauma. The surgery of
tuberculosis. Nelson Awori, Anne Bayley 1999 edition.
11. Serum Human Epididymis Protein 4 (HE4) in the Differential
Diagnosis of Peritoneal Tuberculosis: A Report of Two Cases.
Balkan Med J. 2014 Sep; 31(3): 270–271.
Published
2016-03-31
How to Cite
Pannu, D., Malik, S., Shamsunder, S., & Bhatnagar, A. (2016). Ascites and Adnexal Mass with Raised CA125: How Arduous can be the Path of Diagnosis. Journal of Nepal Medical Association, 54(201), 36-39. https://doi.org/10.31729/jnma.2815
Section
Case Reports