ABSTRACT Background : Tuberculosis (TB) is still major worldwide concern especially at tropical country. Tuberculosis also can infect any place in the body. It is estimated that between 10-25% of TB infections occur extra pulmonary. Abdominal Tuberculosis occurs about 10 % of extra pulmonary tuberculosis. Abdominal Tuberculosis can be easily confused with malignancy. Pseudo Meigs syndrome is co existence of pelvic tumour, hydrothorax, and ascites. It is resembles with metastatic ovarian cancer. Abdominal tuberculosis may resemble with advanced ovarian cancer. Case Report: A married woman, 21 years old, with chief complaint enlargement stomach since 2 weeks before come to the hospital. Patient also had poor intake, low-grade fever, pelvic pain. Cough , weight loss, defecation disturbance, urinated disturbance, enlargement another area were denied. Family history, her father was diagnosed tuberculosis on treatment. Ascites was presented. Thorax X ray found right effusion plural . Complete blood count, albumin, electrolyte serum, renal function test, liver function test were at normal limit. Hepatitis Viral marker were negative. Peritoneal Fluid Analysis found elevated LDH (905 U/L), elevated PMN count 1050/ uL, MN count 3829/ uL, Glucose 68 mg/dL, Protein 7.2 g/dL, SAAG 0.8 mg/dl. ADA test from effusion pleural 4,44 U/L ( within normal limit). A significantly elevated CA-125 level ( 542.5 U/mL). Contrast MSCT abdominal found cyctic lesion with septal and multiple peritumoral lymph node suspected malignant ovarian mass. Laparotomy was done and found serous ascites, multiple nodules attached to the surface of bilateral uterus ½ centimeters and attached to bilateral ovary, and dense adhesions between uterus and rectum. Multiple biopsies were done. Finally, histopathology investigation revealed multinucleated giant cell ( Datia Langhans) with necrotizing granulomatous changes with no malignant cells in all biopsies. Acid fast stain tuberculosis was positive at paraffin block pathology. The patient got anti tuberculosis drugs. After 2 months treatment, patient feel better and there was no complaint enlargement stomach. Until now the patient is on treatment. Discussion The patient presented ascites, pleural effusion, cystic ovarian suggestive of Pseudo-Meigs syndrome. Pseudo Meigs Syndrome is clinically important because resembling of metastatic pelvic cancer. CA-125 is elevated 80% of post menopausal ovarian cancer but not specific and non diagnostic in premenopausal women. SAAG < 1.1 mg / dl indicates non Portal hypertension, caused by infection, malignancy, nephrotic syndrome, or pancreatitis. Finding Datia Langhans at histopathology could be considered as tuberculosis but it can be revealed from another disease. Acid fast stain positive increase the probability of tuberculosis infection. Family history of tuberculosis infection could increase diagnostics value of tuberculosis. Antituberculosis according to the latest protocol led to clinical improvement. Conclusion: Extra Pulmonary Tuberculosis (TB) should be being considered in the differential diagnosis of advanced ovarian cancer, especially in the regions that are endemic for the disease. Keywords : ovarian tuberculosis , peritoneal tuberculosis, tuberculosis

My name is Mona Ebadian and I am currently the dermatology Registrar working in Northampton General Hospital. I have graduated from UCL in 2009 and completed my core medical training in 2015. I am now working as a dermatology registrar and me and my colleagues would like to share our interesting dermatological case which dramatically improved during pregnancy.

We present a case of a 40-year-old female with four years history of widespread rash which had disappeared during her pregnancy and breast feeding period. It reoccurred after breastfeeding was stopped. Her past medical history included IVF, during this time her skin changes remained unchanged. Physical examination showed widespread flat-topped papules 1-2mm in diameter, more prominent on the extensor surfaces of the forearms and trunk. Laboratory tests showed normal FBC, liver and renal function. LDH was within normal level. Autoimmune screen ANA, DsDNA and ENA were negative. Incisional biopsies showed superficial dermal lymphocytic infiltrate and foreign body type granulomas abutting the basal layer of the epidermis. There were no features of eczema, cutaneous T cell lymphoma or keratosis pilaris. The histology was consistent with lichen nitidus. Lichen nitidus is a rare inflammatory skin eruption of unknown cause, which usually affects the upper extremities. The generalised form is even more uncommon. Often no treatment is required and the condition can be self-limiting. To our knowledge there is no previous report of exact cause of Lichen nitidus. There is previous reports that during pregnancy, many women experience remission of autoimmune diseases like multiple sclerosis and uveitis. The pathophysiology is still not well understood, although we know that during pregnancy part of the immune system is downgraded in favour of the growing fetus. As this patients’ skin had completely cleared during pregnancy and breast feeding, we suggest that possibly there may be similar pathophysiology of autoimmune origin involved in Lichen nitidus.

Objective: There is a paucity of data regarding cervical cancer screening in HIV positive women less than 25 years old. Cervical cancer in HIV positive women is known to start at a younger age and progress more rapidly despite adequate antiretroviral treatment, but data in this cohort is limited and lower age limits for screening are difficult to determine. The aim of this study was to determine the incidence of HIV positive women under the age of 25 who test positive for visual inspection with acetic acid (VIA) or have biopsy proven cervical dysplasia. Methods: Retrospective register review of all patients under the age of 25 with VIA screening in the past 2 years (March 2017 to February 2019) at Neno District Hospital, rural Malawi. All women under the age of 25 were recorded and separated them by HIV serostatus. Proportion of women in each group who were VIA negative, VIA positive, suspected cervical cancer, and results of cervical biopsy were compared. Results: A total of 232 women <25 years old were screened for cervical cancer with VIA in 2 years with 182 (78%) women HIV negative, and 50 (21%) women HIV positive. In both the HIV positive and HIV negative groups, there were 2 patients who were VIA positive, respectively. Neither group had biopsy proven cervical cancer; in the HIV negative group, 1 patient (0.5%) was suspected of having cervical cancer but the biopsy returned cervical condyloma. In the HIV positive group, no patients were suspected of cervical cancer and therefore no biopsies were taken. There were no statistically significant differences in the proportions of VIA positivity between either group (p=0.16). Conclusions: These data demonstrate that the risk of cervical dysplasia, cancer, and VIA positivity is very low in patients less than 25 years old regardless of HIV serostatus.   Table 1: Women < 25 years old who underwent VIA screening HIV neg (%) HIV pos (%) P value Total # Screened 182 50 VIA neg 176 (96%) 47 (94%) P = 0.54 VIA pos 2 (1.1%) 2 (4%) P = 0.16 CA suspect 1 (0.55%) 0 (0%) P = 0.6 Either VIA + or CA suspect 3 (1.6%) 2 (4%) P = 0.31 Other Gyn 3 (1.6%) 1 (2%) P = 0.85 Biopsy proven CA or pre-cancer 0 (0%) 0 (0%) -

Intern in Medical Oncology in the Department of Oncology at the Military Hospital of Tunis, Tunisia. I worked previously in the Departments of Medical Oncology at the Farhat Hached University Hospital in Sousse, Tunisia and then at the Salah Azaiez Institute, Tunis, Tunisia

Background : Synchronous presentation of breast and ovarian cancer is rare, it should raise suspicion of a hereditary process.The proportion of breast and ovarian cancers attributed to BRCA 1/2 mutations in the Tunisian population is not yet known. We present this unusual case of combination of breast sarcomatoid carcinoma and ovarian serous carcinoma in a patient with multiple family history of neoplasia. Presentation of the case: A 46-year old patient with a personal history of celiac disease and a multiple family history of neoplasia (4 cases of breast cancer, 2 of ovarian cancer and 4 leukaemias). She was explored in 2018 for mastodynia. The diagnosis of metaplastic fusiform cell carcinoma (sarcomatoid carcinoma) of the breast has been made. She has undergone radical surgery. It was a 5 cm-tumor without lymph node invasion. Immunohistochemical profile was triple negative. The radiological workup noted the presence of 2 ovarian masses measuring 58 and 120 mm with peritoneal carcinosis. A diagnostic laparoscopy for ovarian biopsies was carried out. The histological examination has revealed bilateral ovarian localization of a high-grade serous carcinoma with peritoneal metastases. It is therefore the simultaneous presence of a sarcomatoid breast carcinoma and high-grade metastatic ovarian serous carcinoma. The patient has received 3 cures of Paclitaxel-Carboplatin. A biological and radiological evaluation is planned. Conclusion: This is probably a patient with BRCA mutation. A genetic investigation has been initiated. Earlier screening will be offered to women in her family if a mutation is identified. Prophylactic surgery will also be discussed. The current literature struggles to standardize conduct in these situations. Further studies should be carried out