Pelvic Tuberculosis Diagnosed during Operative Laparoscopy for Suspected Ovarian Cancer

Abstract

Background While the combination of a pelvic mass, very high serum level of CA-125, chest adenopathy, and ascites is concerning for advanced-stage ovarian cancer, the etiology of such a presentation can be due to disseminated pelvic tuberculosis. Case A 67-year-old para 2 African-American woman presented with abdominal pain and shortness of breath. Subsequent CT and MR imaging demonstrated chest adenopathy, a pelvic mass, omental caking, and ascites. The patient underwent diagnostic laparoscopy with biopsy revealing noncaseating granulomas and subsequent tissue culture revealed Mycobacterium tuberculosis. The patient was diagnosed with disseminated pelvic tuberculosis and multidrug therapy was initiated. Conclusion Pelvic tuberculosis can mimic advanced-stage ovarian cancer; thus obtaining a tissue sample may be beneficial to more appropriately direct treatment and planning for neoadjuvant therapies given the ineffectiveness of extensive surgical procedures in treating pelvic tuberculosis commonly employed in the treatment of advanced-stage ovarian cancer.

Laparoscopic evaluation of female genital tuberculosis in infertility: An observational study

“…Laparoscopy can detect more cases of genital TB and abdominal TB by direct viewing of the abdomen and pelvis for various TB findings. Definite findings like beaded tubes, caseous nodules or tubercles or probable findings such as encysted ascites, pelvic, abdominal or perihepatic adhesions, hydrosalpinx, pyosalpinx or tubo-ovarian masses and tubal blockage are seen 5 , 6 , 9 , 13 , 14 .…”

“…Laparoscopy by direct visualization of the abdomen and pelvis can detect most cases of FGTB missed by traditional tests and can be a part of CRS thus, can show a definite or probable finding of FGTB and also help in prognostication of infertility in addition to plan further treatment 5 , 9 , 12 - 14 . Although previous smaller studies of short duration have observed laparoscopy to be useful in the detection of FGTB, a bigger study with large sample size is needed for confirmation of findings of the prior studies.…”

Peritoneal Tuberculosis Mimicking Ovarian Cancer: Gynecologic Ultrasound Evaluation with Histopathological Confirmation

“…Clinically, female genital tract TB usually impacts menstruation, causing amenorrhea, oligomenorrhea, and infertility. Tuberculosis may erode the endometrium and severe body consumption may explain its mechanism [14]. The most common intraoperative findings in TBP are tubo-ovarian masses, ascites, pelvic adhesions, perihepatic adhesions, and caseous or granulomatous nodules.…”

“…Sometimes the diagnosis of TBP can be made instantly when small tubercles (milia) are noted on the peritoneum, but when milia are not present, frozen section is also useful intraoperatively and can avoid unwarranted, extensive surgery [15]. Laparoscopic biopsies of the suspected lesions are an adequate and safe method to make available tissue samples for histologic and bacteriologic diagnosis of TB infection with sensitivity > 80%, especially in the presence of ascites [14,15].…”

Comparative study on complications and difficulties in laparoscopy in female genital tuberculosis cases versus non-tuberculosis cases

“…Laparoscopy has the advantage of direct visualisation of the abdomen and pelvis for subtle signs of FGTB and can show a definite or probable finding of FGTB and can also help in prognostication of infertility and to plan further treatment. [ 1 2 3 9 10 11 ] However, laparoscopy may be hazardous in FGTB and abdominopelvic TB. [ 12 ] The purpose of the current study was to observe difficulties and complications observed in FGTB patients as compared to control cases of laparoscopy performed for infertility in the absence of FGTB.…”