Peritoneal tuberculosis mimicking advanced ovarian cancer: A retrospective review of 22 cases
Introduction
Patients with ascites, abdominopelvic masses and elevated serum CA125 levels are considered to have ovarian or gastrointestinal system malignancy. Reports of peritoneal tuberculosis (peritoneal tbc) in the literature have been primarily limited to sporadic case studies which had been often misdiagnosed as carcinomatous peritonitis [1], [2]. Many series evaluated using current diagnostic tools for women with peritoneal tbc have yielded inconsistent results.
Although pulmonary tuberculosis is a common disease in developing countries, because of diagnostic difficulties, patients diagnosed peritoneal tbc are limited. Tuberculous peritonitis is a form of abdominal tuberculosis that predominantly involves the omentum, intestinal tract, liver, spleen or female genital tract in addition to parietal and visseral peritoneum [3]. Peritoneal tbc is currently defined to account for approximately 1–2% of all tuberculosis cases and, sometimes it is seen in association with pulmonary or disseminated form of the disease. The final diagnosis in such cases could only be achieved by tissue biopsies taken with laparoscopy or laparotomy.
In this paper, we present 22 cases of peritoneal tbc who were diagnosed at Gynecologic Oncology Clinic of TCSB Ankara Etlik Maternity and Women's Health Teaching and Research Hospital. The aim of this retrospective study is to identify characteristic feature of peritoneal tbc, which may be useful for differential diagnosis. The above data suggest that clinical features of such cases are not characteristic and that frozen section seems to be the sole tool both in confirming the diagnosis of tbc and in identifying occult disease that may be undiagnosed clinically. We noticed that tissue biopsies are necessary for the diagnosis of this apparently serious but curable infection which appears to be similar to an advanced stage ovarian carcinoma clinical presentation.
Section snippets
Methods
From July 1992 to November 2004, all patients who were suspected for ovarian cancer preoperatively and managed at Gynecologic Oncology Department of TCSB Ankara Etlik Maternity and Women's Health Teaching and Research Hospital were reviewed. During the study period, 22 women (1.2%) with peritoneal tuberculosis from a total of 1826 were submitted for this retrospective review (Table 1). Complete physical examination, medical and family history, complete blood count, routine biochemical tests, Ca
Results
The mean age of the patients was 36.9 years (range 21–68 years) (Table 2). The most common symptoms were abdominal swelling and pain (Table 3). The onset of the symptoms varied between 2 weeks and up to 1 year. None of the patients was receiving immune suppressive therapy and had family or past history for tbc. Ascites on ultrasonographic examination was shown to be present in all patients. A diagnosis of peritoneal tbc was ultimately established by surgery in 20 patients, although only 2 of 22
Discussion
The clinical features of symptomatic peritoneal tbc may resemble chronic pelvic inflammatory disease (PID) or any other pelvic disorders including ovarian cancer. Because many cases of peritoneal tbc are discovered incidentally and since majority of symptomless patients remain undiscovered, the precise incidence of peritoneal tbc in the developing countries cannot be determined. The present data have been collected from our selected population at gynecologic oncology unit and do not indicate
Conclusion
The rarity of peritoneal tbc in females contributes to a low index of suspicion and therefore a low incidence of accurate preoperative diagnosis. Routine physical, radiographic and laboratory examinations are not sensitive enough to determine the presence of peritoneal tbc or to differentiate those from advanced ovarian cancers. Ultrasonography and computed tomography have limited usefulness in evaluating peritoneal tbc because of diffuse nature and small implants associated with the disease.
References (22)
- et al.
Tuberculous peritonitis; part of the differential diagnosis in ovarian cancer
Am. J. Obstet. Gynecol.
(2000) - et al.
Indication for peritoneal biopsy in tuberculous peritonitis
Am. J. Surg.
(2003) - et al.
Case report: peritoneal tuberculosis disguised as ovarian cancer: an emerging clinical challenge
Gynecol. Oncol.
(2002) - et al.
A patient presenting with pelvic mass, elevated Ca-125, and fever
Gynecol. Oncol.
(2000) - et al.
Tuberculous peritonitis of the wet ascitic type: clinical features and diagnostic value of image-guided peritoneal biopsy
Dig. Liver. Dis.
(2004) - et al.
The usefulness of PCR amplification of the IS6110 insertion element of M. tuberculosis complex in ascitic fluid of patients with peritoneal tuberculosis
Eur. J. Intern. Med.
(2003) - et al.
Peritoneal tuberculosis revealed by carcinomatosis on CT scan and uptake at FDG-PET
Br. J. Obstet. Gynaecol.
(2003) - et al.
Peritoneal tuberculosis—an uncommon disease that may deceive the gynecologist
Eur. J. Obstet. Gynecol. Reprod. Biol.
(2003) - et al.
Tuberculous peritonitis-reports of 26 cases, detailing diagnostic and therapeutic problems
Eur. J. Gastroenterol. Hepatol.
(2001) - et al.
Tuberculous peritonitis mimicking peritonitis carcinomatosis: a case report
Eur. J. Pediatr.
(2003)
Overview of clinical tuberculosis
Cited by (85)
Incidental encounter of intraperitoneal tuberculosis during renal surgeries: A surgeon's dilemma
2022, Indian Journal of TuberculosisComputed tomographic findings in female genital tuberculosis tubo-ovarian masses
2022, Indian Journal of TuberculosisPeritoneal tuberculosis mimicking advanced ovarian cancer case report: Laparoscopy as diagnostic modality
2021, International Journal of Surgery Case ReportsCitation Excerpt :The massive volume of ascites suggests that the blocking process is comprehensive. Peritoneal TB is one extrapulmonary which is rare and difficult to diagnose, accounting for 1% - 2% of all tuberculosis cases [2]. Tuberculosis is a major health problem in a developing country, WHO reported an estimated 9.4 million cases of TB globally in 2009, and most of the cases were from developing countries [5].
Co-existent abdominoperitoneal tuberculosis with endometrial cancer: A diagnostic and surgical challenge
2021, Gynecologic Oncology ReportsIncidental detection of disseminated peritoneal tuberculosis-varied presentation
2020, Indian Journal of TuberculosisTuberculous peritonitis mimicking carcinomatosis peritonei: CT findings and histopathologic correlation
2019, Radiology Case ReportsCitation Excerpt :Diagnosis of tuberculous peritonitis with clinical, laboratory, and imaging findings is a difficult process. Tuberculous peritonitis accounts for 1%-2% of all cases of tuberculosis and occurs when abdominal or pelvic tuberculosis involves the peritoneum [1,2]. Tuberculous peritonitis and carcinomatosis peritonei have many common clinical, laboratory, and radiological findings [3,4].