Peritoneal tuberculosis with pelvic abdominal mass, ascites and elevated CA 125 mimicking advanced ovarian carcinoma: A series of 10 cases

Abstract

Ten patients with peritoneal tuberculosis who were operated on for suspected advanced ovarian cancer during a 5-year period were analyzed. These 10 cases constituted 1.4% of the 728 new gynecologic cancer cases diagnosed and treated at our department during the same time period. Data were obtained from patients' files and pathology reports. The mean age of cases was 40.6 +/- 6.1 (median 37; range 18-72). Ascites was present together with ill-defined nodularities or thickening in the Douglas pouch and/or in the adnexal areas on pelvic examination in all patients but three, who presented with well-demarcated adnexal masses of about 5 cm in diameter. All patients had elevated serum CA 125 levels with a median of 331 U/ml, (40-560 U/ml). Ultrasound and abdominopelvic CT examinations revealed omental and mesenteric thickening in addition to ascites in all patients, cystic ovarian masses or ovarian enlargement in five, and peritoneal implants in two. Abdominal paracentesis performed in the six cases in whom the findings were felt to be most inconclusive for the diagnosis of ovarian cancer revealed clear exudative fluid with benign cells. Mycobacteria could not be demonstrated on direct preparations. Tuberculosis was diagnosed at laparotomy in all. Patients received antituberculous therapy and serum CA 125 levels returned to normal within 2 months after the beginning of treatment. This case series demonstrates a high rate of misdiagnosis between advanced ovarian cancer and peritoneal tuberculosis. Whereas abdominal paracentesis is useless in ruling out peritoneal tuberculosis, and serum CA 125 levels are not helpful in the differential diagnosis, the latter marker may be useful in the follow-up of patients.

Abdominal Tuberculosis: a Benign Differential Diagnosis for Peritoneal Carcinosis: Report of a Case

“…There are several case studies resembling our case, which describe peritoneal tuberculosis mimicking advanced ovarian cancer due to similar clinical presentation and serology [10][11][12][13]. The clinical and serological constellations described resemble that of our patient, namely ascites, omental thickening, irregularities in the abdomen and pelvis, and elevated CA-125 level; however, none of these patients had a splenic lesion.…”

Assessment of 35 children with abdominal tuberculosis

“…The presence of acid-fast bacilli in peritoneal fluid with positive culture has rarely been reported in the literature (29,(34)(35)(36). Bölükbaş et al (37), in a series of 88 cases of abdominal tuberculosis, calculated the microbiological diagnostic ratio as 11%.…”

Role of Imaging in Peritoneal Surface Malignancies

“…[65] There are three forms of tuberculous peritonitis: the Bwet^(with ascites), the Bdry^(peritoneal involvement without ascites) and the Bfibroid^type (with profound omental thickening and extensive adhesion formation). [66,67] TB peritonitis can have similar findings as ovarian cancer and is even more difficult to distinguish from it in immunocompromised patients. Analysis of ascitic fluid analysis is can be nonspecific.…”