Introduction/Background Tuberculosis, as a specific granulomatous inflammation, although considered a disease of the past, remains a global problem and a diagnostic challenge, especially abdominal tuberculosis, which accounts for only 3.5% of extrapulmonary tuberculosis cases. In N. Macedonia the latest value from 2021 is 11 tuberculosis cases per 100,000 people, for comparison, the world average in 2021 based on 193 countries is 99.18 cases per 100,000 people. Abdominal tuberculosis and ovarian malignancy can present with similar symptoms, laboratory, and imaging findings that further complicate their diagnosis and differentiation.

Case Report A 19-year-old female patient, with a low socioeconomic status and regular vaccinations, was evaluated with adnexal mass and ascites fluid. From performed laboratory analyzes we marked an increased value for tumor marker Ca125=428 U/ml and a low value for hemoglobin 101 g/l. X-ray of lungs was with normal findings. The gynecological ultrasound finding correlates with CT of the small pelvis and supports a changed right adnexa with an irregular and vaguely limited solid change with a diameter of 45x35mm and a large amount of free fluid in the small pelvis, perileanally and interintestinally. The differential diagnostic investigations carried out indicated a suspicion of advanced ovarian malignancy, for which a decision was made for a explorative laparotomy. The intraoperative macroscopic finding confirmed suspicious for advanced ovarian malignancy with the presence of ascitic fluid, omental cake, ovarian changes and parietal peritoneum. But histopathology results concluded specific granulomatous inflammation whose morphology is in favor of tuberculosis without malignancy signs. Postoperatively, the patient was referred and treated in an appropriate institution for the treatment of TB diseases.

Conclusion High values for Ca125 and the presence of ascites do not always indicate a clinical picture of malignancy in reproductive women. The diagnosis of abdominal tuberculosis remains a clinical challenge due to its frequent identification with ovarian malignancy.

Disclosures No conflicts of interest are reported