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

Abstract

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.