Peritoneal Sarcoidosis Mimicking Peritoneal Tuberculosis and Advanced Ovarian Carcinoma

Abstract

<jats:p>Sarcoidosis is an inflammatory disease that affects one or multiple organs, most commonly the lungs and lymph nodes. This disease can present in a variety of ways which often makes diagnosis difficult. A 54-year-old postmenopausal African American female with a history of omental carcinomatosis of unknown origin was referred to the gynecology-oncology service at a local community hospital following a laparoscopic incarcerated hernia repair where multiple abdominal lesions suspicious of ovarian carcinomatosis were visualized. She was brought to the operating room for a diagnostic laparoscopy at which point the intra-abdominal survey revealed white tubercle-like lesions that were consistent with peritoneal tuberculosis. The lesions were excised and sent to pathology. The omentum biopsy was originally reported as adipose tissue showing focal fibrosis, focal mild acute inflammation, few cyst formation, and multiple granulomatous chronic inflammation, with multinucleated giant cells. Periodic acid-Schiff stain and acid fast bacilli stain were negative, and a diagnosis of peritoneal tuberculosis was made. The patient was started on an antituberculosis treatment regimen; however, she was not improving. The pathology slides were reexamined and revealed nonnecrotizing granulomatous inflammation consistent with sarcoidosis. The patient was immediately referred to the department of pulmonology and rheumatology, at which point she was started on corticosteroids and had an improvement in her condition.</jats:p>

Sarcoidosis presenting as ovarian mass with omental and peritoneal nodules with elevated CA 125 level; mimicking malignancy

“…Sarcoidosis can affect males and females of all races but it is more prevalent in European, African-American, Swedish and Danish individuals, but rare in Indians, possibly due to lack of screening programs and predominance of other common granulomatous diseases like tuberculosis, fungal infections and leprosy. 1,5 Ovarian sarcoidosis presenting as adnexal mass is extremely rare whether as a component of systemic disease or as an isolated feature. 1 Most cases occurred in the reproductive age group, although a few have been reported in postmenopausal women.…”