Co-existent Ovarian Tuberculosis with Borderline Serous Cyst Adenoma in an Infertile Young Female: A Case Report

Genital tuberculosis involving the ovary in young non immunocompromised females is rare, and its coexistence with serous neoplasm makes it even rare and diagnostically challenging. A 32-years-old female patient, presented with primary infertility and abdominal pain. Menstrual history was unremarkable; her Ultrasound (USG) abdomen revealed an anechoic cyst in left ovary with normal right ovary, uterus, and cervix. Serum Carbohydrate Antigen (CA)-125 was 226 IU/mL. Laparotomy with cystectomy was performed, and gross examination revealed a cystic lesion with a small papillaroid growth. Microscopic examination predominantly displayed large coalescing epithelioid granuloma, multinucleate giant cells, and dense inflammation. On careful examination, the sections further revealed areas of irregular glands lined by single layer of cuboidal columnar cells with homogenous chromatin and moderate eosinophilia cytoplasm. These glands were seen infiltrating the ovarian parenchyma. However, the total depth of invasion was not more than 3 mm in any area. Morphological differentials of granulomatous lesion with borderline ovarian tumour or any metastatic adenocarcinoma was made. Further immunohistochemical workup was done and the tumour cells showed strong nuclear positivity for Wilms’ Tumor suppressor gene1 (WT1) and Paired-box gene 8 (PAX8), confirming the presence of serous ovarian lesion. As the total depth of invasion was upto 3 mm according to World Health Organisation (WHO) 2020 the lesion was classified as borderline serous neoplasm with microinvasion over shadowed by the tubercular component in the same ovary. Interestingly, both may result infertility in a young female. Above case emphasises on the importance of careful morphological assessment in delineating two different pathologies occurring in same organ which is clinically relevant.