Peritoneal tuberculosis mimicking advanced ovarian cancer case report: Laparoscopy as diagnostic modality

Abstract

Introduction and importance Peritoneal Tuberculosis is one of extrapulmonary tuberculosis that occurs in 1-2% of patients, its incidence is higher in developing countries. It is very difficult to diagnosed and can mimic advanced ovarian cases. Making an accurate diagnosis is vital, laparoscopy is a great modality for this purpose. Case presentation A 36 years-old woman got referred with abdominal distention and weight loss from an internist and digestive surgeon. The abdominal computed tomography said thickening of the stomach wall with ascites. Ultrasound concluded the uterus, ovary, and endometrium within normal. The CA 125 levels elevated to 1200 U/mL and the complete blood count was normal. We were making diagnosis of peritoneal tuberculosis, peritoneal carcinomatosis, and advanced ovarian cancer. We did the diagnostic laparoscopic and taking a biopsy sample, ascites with peritoneal carcinomatosis and omental cake were found, the peritoneal cavity was covered by miliary nodules. Histopathology results concluded peritoneal tuberculosis without malignancy signs. The patient was treated with tuberculosis drugs. The follow-up evaluations show significant clinical improvement. Clinical discussion When facing patients with massive ascites and elevated CA 125 without any ovary enlargement, a gynecologist should think that it may be a peritoneal TB case with peritoneal carcinomatosis and advance ovarian cancer possibility as differential diagnosis especially in developing countries. An exact diagnosis can be made using laparoscopy and histopathology examination. Conclusion Laparoscopy is the best modality to differentiate between peritoneal tuberculosis, peritoneal carcinomatosis, and advance ovarian cancer. The benefits are direct visualization and could take a biopsy for histology examination.

Peritoneal Tuberculosis Mimicking Peritoneal Carcinomatosis in an Immunocompetent Patient

“…Any kind of peritoneal disease has been associated with an increased level of CA-125, and hence, it is an unreliable investigation in this case. This is also supported by a similar case report by Purbadi et al, where the CA-125 level was found to be 1,200 U/mL [ 10 ], which is much higher than our case.…”

Diagnosis challenges of a patient with peritoneal tuberculosis masquerading as ovarian malignancy: a case report

“…Microscopically, the important diagnostic clue is a large confluent granulomas with central caseous necrosis; while tissue PCR is positive in 25-70%. 7, 10 The results of BTA staining from the pus deep sample showed the formation of BTA positive bacteria and PMN +3 cells, the results of pathological examination showed pieces of connective tissue and fat with groups of epithelioidshaped histiocyte cells that formed granulomas, with datia Langhans cells and lymphocytes scattered at the edges. In the middle, caseous necrosis appears to form soft tubercles.…”

“…8, 9 Especially due to non-specific abdominal or pelvic symptoms such as masses, ascites, that can mimic cases of advanced ovarian cancer. 10 Ovarian carcinoma biomarker, Ca125, has been reported to be elevated in patients with pulmonary and extrapulmonary TB including PTB. 2, 11 A study showed that the serum CA-125 level was elevated approximately 44% of patients with active pulmonary TB.…”

“…2 Management and clinical outcomes between PTB and advanced ovarian cancer are very different. 10 PTB treated with antituberculosis drugs, and can be cured. In contrast, advanced ovarian cancer should be treated with debulking surgery followed by cytotoxic drugs and with a worse clinical outcome.…”

“…In contrast, advanced ovarian cancer should be treated with debulking surgery followed by cytotoxic drugs and with a worse clinical outcome. 10 Therefore, comprehensive and conscientious examinations are needed to differentiate such cases in order to provide proper treatment. 8 We report a case of problematic diagnosis of PTB with an initial suspicion of ovarian malignancy.…”