Ovarian Carcinoma or Abdominal Tuberculosis?—A Diagnostic Dilemma: Study of Fifteen Cases

Abstract

Objective To evaluate the clinical, laboratory, and diagnostic features in women with abdominal tuberculosis that resembled advanced ovarian malignancy. Methods A retrospective review of women with abdominal tuberculosis who were managed at GCRI Ahmedabad from 1996 to 2001 was undertaken. Results Fifteen patients (3.06 %) with suspected ovarian cancer cases, finally diagnosed as abdominal tuberculosis over a 6-year period (1996)(1997)(1998)(1999)(2000)(2001), are analyzed. During this period, 492 patients were operated for suspected ovarian malignancy. Pre-operatively, ultrasound-guided biopsies were inconclusive in 14 cases and hence, exploratory laparotomy was planned. They underwent laparotomy and biopsy for final diagnosis. Frozen sections-of peritoneal/ omental biopsies in 11 cases and ovarian tumour in three cases-were indicative of tuberculosis in all the 14 cases. Conclusion The data of this study indicate that the majority of the cases with peritoneal tuberculosis can be diagnosed intra-operatively through the use of frozen section in conjunction with clinical features. Ascites and high levels of Ca125 do not necessarily indicate that the clinical picture is malignant in reproductive women. Laparoscopic tissue biopsy may be a fundamental tool in the management of such cases to avoid extended surgery.

Peritoneal Tuberculosis: A Forsaken Yet Misleading Diagnosis

“…In spite of thorough investigations, exploratory laparoscopy and/or laparotomy may be necessary for ruling out ovarian malignancy or confirming abdominal tuberculosis [1]. As in our case, despite repetitive nonconclusive and negative investigations, surgical biopsy was finally diagnostic of a tuberculous granuloma.…”

“…In women presenting with abdominal discomfort, abdomino-pelvic mass, weight loss, ascites, and elevated levels of CA 125, the first diagnosis to be afraid of is ovarian cancer. However, abdominal tuberculosis can present with the same vague symptoms, and it is an important differential diagnosis to consider and to hope in a minor subset of lucky women [1]. Worldwide, the prevalence of extrapulmonary tuberculosis is increasing parallel to the rise of acquired immunodeficiency syndrome (AIDS), mainly in developing countries, with around 12% of abdominal involvement [2].…”

Early stage ovarian carcinoma with symptoms mimicking tuberculous peritonitis in a postmenopausal woman

“…However, the CT findings of tuberculous peritonitis and peritoneal carcinomatosis are similar, and it is difficult to correctly differentiate these diseases. [ 13 ] Particularly when the ovary is normal-sized with peritoneal fat infiltration, differentiating between benign and malignant peritonitis may be difficult. In particular, the CT findings of ovarian cancer and tuberculous peritonitis are comparable, although ovarian capsular change and ovarian parenchymal attenuation are distinctive distinguishing features.…”

Peri and post-menopausal women with complex adnexal masses, ascites, and raised CA-125: Is it ovarian cancer or tuberculosis?

“…Whenever peritoneal TB is suspected intraoperatively, frozen section histology should be utilized so that unnecessary surgery is prevented. [8] A diagnostic tool which may differentiate between the two conditions in the future is the Xpert ® MTB/RIF assay. It is a real-time PCR assay that can be used by operators with minimal technical expertise, enabling diagnosis of TB and assessment of rifampicin resistance and has been endorsed by the WHO recently.…”