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


  • Renuka Badanale Department Pathology, Rashtrasant Tukdoji Tertiary Care Cancer Centre, Nagpur, Maharashtra, India



CA 125, Omental nodules, Ovarian mass, Sarcoidosis


Sarcoidosis is a systemic inflammatory disease of unknown aetiology with a variety of nonspecific clinicoradiological features making diagnosis challenging. Sarcoidosis commonly involves pulmonary and lymphoreticular systems; ovarian involvement being extremely rare. We present a case of a 50-year Indian postmenopausal female, with a history of abdominal pain and distension, referred from the peripheral hospital for management of a solid complex left adnexal mass and elevated CA 125 levels. Based on ultrasonography and contrast-enhanced computed tomography, ovarian carcinoma was a differential diagnosis. Ascitic and pleural fluid cytology and ovarian fine needle aspiration cytology (FNAC) didn’t give any conclusive diagnosis. Hence surgical intervention was carried out. Histopathology revealed noncaseating granulomas in ovaries, peritoneum, and omentum. Tissue polymerase chain reaction (PCR) for tuberculous and nontuberculous mycobacteria was negative. Post-operatively serum angiotensin-converting enzyme (ACE) and calcium levels were elevated. These findings supported the diagnosis of sarcoidosis and the patient responded well to systemic steroids.



Porter N, Beynon HL, Randeva HS. Endocrine and reproductive manifestations of sarcoidosis. Q J Med. 2003;96:553-61.

Wuntakal R, Bharathon R, Rackall A, Jejarah A. Interesting case of ovarian sarcoidosis: The value of multi-disciplinary team working. World J Surg Oncol. 2007;5:38.

Hunninghake GW, Costabel U, Ando M, Baughman R, Cordier JF, du Bois R, et al. ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis. 1999;16:149-73.

Warshauer DM, Lee JK. Imaging manifestations of abdominal sarcoidosis. Am J Roentgenol. 2004;182:15-28.

Robles BN, Shea C, Salame G. Peritoneal Sarcoidosis Mimicking Peritoneal Tuberculosis and Advanced Ovarian Carcinoma. Case Rep Obstet Gynecol. 2020;1905649.

Kalluri M, Judson MA. Sarcoidosis associated with an elevated serum CA 125 level: description of a case and a review of the literature. Am J Med Sci. 2007;334:441-3.

Ungprasert P, Carmona EM, Crowson CS, Matteson EL. Diagnostic utility of angiotensin-converting enzyme in sarcoidosis: a population-based study. Lung. 2016;194:91-5.

Zeimer HJ, Greenaway TM, Slavin J, Hards DK, Zhou H, Doery JC, et al. Parathyroidhormone- related protein in sarcoidosis. Am J Pathol. 1998;152:17-21.

McCluggage WG, Allen DC. Ovarian granulomas: a report of 32 cases. J Clin Pathol. 1997;50:324-7.

Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, et al. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2020;201:e26-51.






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