A Large Pelvic Mass in an Adolescent Patient with Granulomatous Nephritis: Case Report and Discussion of Treatment Challenges

摘要: Abstract Background An adolescent patient with granulomatous nephritis presents a large, solid pelvic mass. Pertinent differential diagnosis for this ovarian mass as well discussion regarding treatment challenges is delineated. Case A 15-year-old female presented to her primary care doctor fatigue and syncope. Initial laboratory workup revealed hemoglobin of 7.9 g/dL, an elevated creatinine 3.5 mmol/L, ionized calcium 13.1 mg/dL. Renal biopsy diffuse non-caseating rare acid-fast bacilli. ultrasound first noted Pelvic 15.0 × 8.4 12.2cm mass, characterized mostly spaces, in the location right ovary. CA-125 lactate dehydrogenase (LDH) tumor markers were elevated. The underwent left salpingo-oophorectomy staging. Intra-operative frozen section dysgerminoma. Final pathology report extensive inflammation within tumor. Special stains showed no evidence organisms. Conclusion Dysgerminoma most likely age. In light initial renal bacilli, tuberculosis needs be considered. Due its extreme rarity, sarcoidosis genital tract should lower on differential, yet consistent granulomas suggesting diagnosis. Once dysgerminoma was diagnosed, possibility that patient's findings may represent paraneoplastic syndrome also becomes important treatment.