Peripartum disseminated extrapulmonary tuberculosis simulating ovarian carcinoma.

Disseminated extrapulmonary tuberculosis is an uncommon complication of pregnancy. We present a 26-year-old multiparous immigrant from Haiti who was admitted following an extramural preterm delivery. Marked ascites was confirmed by computerized tomography, which also revealed a thickened greater omentum. These findings were considered suggestive of advanced ovarian carcinoma, although extrapulmonary tuberculosis was also considered despite negative tuberculin skin test screening. Image-guided omental biopsy demonstrated caseating granulomas substantiating the diagnosis of abdominal tuberculosis, which was later confirmed by cultures. The patient responded well to antituberculosis medications. This case describes the unusual peripartum presentation of abdominal tuberculosis simulating advanced ovarian carcinoma, and demonstrates the importance of considering extrapulmonary tuberculosis when encountering ascites and omental thickening during pregnancy despite negative tuberculin skin test screening.

Stage IV large B cell lymphoma presenting as gigantomastia and pulmonary hypertension.

BACKGROUND: Gigantomastia is a rare complication of pregnancy usually associated with benign conditions, including end-organ hypersensitivity to normal hormone levels, penicillamine therapy, mirror syndrome, and benign or glandular fibroadenomas. CASE: A young woman presented at 30 weeks of gestation with chest pain and gigantomastia. Echocardiography performed because of the patient's tachypnea and tachycardia disclosed pulmonary hypertension. After spontaneous delivery, core needle breast and axillary lymph node biopsies and computerized tomography imaging were performed, and stage IV diffuse large B cell lymphoma with infiltration of the breasts was confirmed. The patient responded to systemic chemotherapy with resolution of the gigantomastia and pulmonary artery hypertension. CONCLUSION: This case demonstrates that systemic malignancies such as diffuse large B cell lymphoma should be considered in the differential diagnosis of gigantomastia during pregnancy. In addition, malignancy-related pulmonary hypertension during pregnancy may be reversible after chemotherapy, as reported in nonpregnant patients.