Peritoneal tuberculosis simulating advanced ovarian carcinoma: is clinical impression sufficient to administer neoadjuvant chemotherapy for advanced ovarian cancer?

Abstract

Peritoneal tuberculosis mimics advanced ovarian cancer because of the similarities in clinical signs and symptoms such as ascites, pelvic and abdominal pain and mass, and elevation of serum CA125 level. We have presented four cases of peritoneal tuberculosis that underwent exploratory laparotomy for suspected advanced ovarian cancer during a 3-year period. Definitive diagnosis of tuberculosis was performed at laparotomy in all the cases. The frozen-section analysis seems to be the gold standard in the differential diagnosis. In view of these data, clinical diagnosis of advanced ovarian cancer is not sufficient for administering neoadjuvant chemotherapy. Cytologic or pathologic findings must be consistent with ovarian cancer for candidates who are being considered for neoadjuvant chemotherapy.

Pelvic tuberculosis, echinococcosis, and actinomycosis: Great imitators of ovarian cancer

“…In our study, the mean age of the women with PT was 39.8 ± 9.5 (range, 27–59) years. Although some reports have suggested performing a laparoscopic biopsy to achieve a histological diagnosis, a laparotomy might be more appropriate because the extensive adhesions in the abdomen caused by peritoneal tuberculosis can increase the risk of intestinal complications during laparoscopy . During laparoscopy or laparotomy, the gross appearance of peritoneal tuberculosis can resemble advanced ovarian carcinoma, and a frozen section is mandatory to discriminate the two clinical entities .…”

A deceiving disease in women for clinicians: peritoneal tuberculosis

“…The diagnosis of peritoneal TB is best made through evaluation of suspect tissue. Typically, infected tissue demonstrates granulomatous inflammation with central necrosis, which is extremely suggestive of peritoneal TB [7]. Laparoscopy seems to be an efficient and safe method to provide tissue samples because of the lower risk of complications when compared with laparotomy.…”

“…The World Health Organization (WHO) reported an estimated 9.4 million cases of TB globally in 2009, while 7% of the cases were from Mediterranean countries [6]. Peritoneal TB is estimated to account for 1-2% of all TB cases and its association with pulmonary disease is not well defined [7]. The exact diagnosis can only be confirmed by tissue biopsies obtained from laparoscopy or laparotomy.…”

Tuberculosis peritoneal con presentación clínica como cáncer ovárico avanzado: revisión de la literatura

“…Manifestaciones clínicas: En la mayoría de los casos son inespecíficas (6-10), siendo los síntomas más frecuentes la ascitis (93%), dolor abdominal (73%), pérdida de peso (40% a 90%), y fiebre (58%) (7). En muchas pacientes se presenta clínicamente en forma de un complejo sintomático similar al de un carcinoma ovárico avanzado (distensión abdominal, tumor pélvico, ascitis y CA125 elevado), pudiendo fácilmente confundirse con esta entidad (8,9,(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31). En estos casos, así como el cuadro clínico es parecido, la tomografía computada también puede mostrar cambios morfológicos similares, tales como ascitis, imágenes sugerentes de carcinomatosis peritoneal (engrosamiento peritoneal parietal y omental), masa abdominal o pelviana en región tomográfica ovárica, nódulos linfáticos con centros de baja densidad y linfadenopatía.…”

“…En los casos en los cuales se plantea el diagnóstico diferencial con un carcinoma ovárico avanzado, es necesaria la biopsia intraoperatoria de las lesiones para confirmar el diagnóstico (8,16,17,18,20,23,24,31,34), como fue en nuestro caso, dado que el tratamiento quirúrgico extenso de un carcinoma ovárico es muy diferente del tratamiento médico de la TBP (8). La confirmación del diagnóstico de TBP en esta etapa le evita a la paciente el sometimiento a una cirugía mayor innecesaria (8,17,23,24,31,34).…”