Primary ovarian parasitic diseases mimicking ovarian cancer in the reproductive system: diagnostic challenges and surgical challenges (a case report)

Primary ovarian parasitic disease is rare and can masquerade as advanced ovarian carcinoma; we report the first detailed case in a post-menopausal woman that underscores this diagnostic trap. A 51-year-old woman with chronic raw-seafood ingestion presented with bilateral adnexal masses (7cm left, 5cm right), low-grade fever, leukocytosis (13.2 × 109/L), markedly elevated C-reactive protein (135mg/L) and CA-125 (69.5U/mL), and imaging suggesting ovarian malignancy with ascites. Intra-operatively, a "frozen pelvis" with dense adhesions, multiple abscesses and omental cake was found; frozen section excluded neoplasia, leading to total hysterectomy, bilateral salpingo-oophorectomy, appendectomy and abscess debridement guided by infectious-disease principles. Histopathology revealed chronic suppurative granulomatous inflammation with parasitic remnants consistent with echinococcal disease, and the patient remains disease-free at 5 years. Clinicians should include parasitic infection in the differential of complex pelvic masses in patients with raw-food exposure; complete excision adhering to anti-infective surgical protocols prevents misdiagnosis as malignancy and avoids unnecessary oncologic overtreatment.