Ovarian tumour-cutaneous fistula as a primary presentation of pelvic malakoplakia coexisting with a benign ovarian tumour mimicking advanced ovarian cancer

• Published in: BMJ case reports Vol. 17; no. 6; p. e260990
• Main Authors: Aue-aungkul, Apiwat, Muktabhant, Chawiporn, Kleebkaow, Pilaiwan
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 24.06.2024; BMJ Publishing Group LTD
• Subjects: Abdomen; Abscesses; Antibiotics; Antigens; Cancer therapies; Case reports; Cellular biology; Cutaneous Fistula - diagnosis; Cutaneous Fistula - etiology; Cystadenoma, Mucinous - complications; Cystadenoma, Mucinous - diagnosis; Cystadenoma, Mucinous - surgery; Cysts; Diagnosis, Differential; Endometriosis; Female; Fistula; Granulomas; Gynecological cancer; Gynecology; Humans; Immunohistochemistry; Infections; Laparotomy; Malacoplakia - complications; Malacoplakia - diagnosis; Medical imaging; Middle Aged; Obstetrics and gynaecology; Oophorectomy; Ovarian cancer; Ovarian Neoplasms - complications; Ovarian Neoplasms - diagnosis; Ovarian Neoplasms - pathology; Pelvis; Pleural effusion; Pleural infection; Skin; Surgery; Tumors; Urinary and genital tract disorders; Immunohistochemistry; Gynecological cancer; Pleural infection; Urinary and genital tract disorders
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2024-260990

Malakoplakia is a rare granulomatous, chronic inflammatory disease generally affecting the urogenital organs, though it can arise in other organs. The clinical manifestations of malakoplakia vary depending on the affected organ. The final diagnosis is confirmed by the presence of Michaelis-Gutmann bodies on pathology. This report describes a case of pelvic malakoplakia accompanied by an ovarian tumour-cutaneous fistula, initially misdiagnosed as advanced ovarian cancer invading the anterior abdominal wall with left pleural effusion based on imaging studies and increased serum carbohydrate antigen 19-9. The patient underwent left thoracentesis and fluid collection from the fistula tract for cytology, which showed no malignancy. She underwent primary debulking surgery, including removal of the fistula tract from anterior abdominal wall. Histopathological examination revealed malakoplakia coexisting with mucinous cystadenoma of the left ovary. For postoperative management, she received prolonged oral antibiotics for 6 months. There was no evidence of disease recurrence at the 24-month follow-up.