To establish more effective diagnostic procedures to identify the characteristic features of abdominopelvic tuberculosis (APTB) mimicking advanced ovarian cancer. A retrospective review of 20 cases of APTB mimicking advanced ovarian cancer was undertaken. The mean age of the patients was 28.9 ± 10.8 years. The main clinical manifestations were abdominal pain (45%) and distention (45%). CA125 level was elevated in 18 cases (90.0%). Pelvic mass in 18 patients (90.0%) and ascites in 12 patients (60.0%) were detected by using abdominal US. The bacteriologic cultures and cytological studies were all negative (10 cases, 100%). Laparotomy (17 cases) and laparoscopic evaluation (1 case) was performed with the presumptive diagnosis of advanced ovarian cancer except for 2 patients treated with diagnostic anti-TB chemotherapy. The common intra-operative findings were miliary nodules (14 cases, 77.8%) and widespread adhesion (10 cases, 55.6%). Intra-operative frozen section was obtained in 10 cases, and the typical tuberculosis tubercles were detected in all cases. APTB should be considered in all cases with pelvic mass, ascites and high levels of CA125, although clinical features and laboratory results specifically indicate neither ovarian malignancy nor APTB. Diagnostic laparotomy is a direct and safe method. To avoid extended surgery, the cases with APTB can be diagnosed through intra-operative frozen section in conjunction with clinical features.

Diagnostic dilemma of abdominopelvic tuberculosis:a series of 20 cases

Peritoneal tuberculosis is a rare form of extrapulmonary tuberculosis1. It remains a difficult disease to diagnose because of the nonspecific clinical picture and radiological findings that can mimic malignancy. Here, we report a case of peritoneal tuberculosis with high serum levels of CA 125, which is a specific determinant for epithelial ovarian carcinomas. We also used CA 125 for monitoring the response to the anti-tuberculous treatment.

A case of tuberculous peritonitis with elevated CA 125.

T‹berk‹loz per0ton0t0: b0r olgu sunumu tuberculous per0ton0t0s: a case report

A 49 year old woman presented with weight loss, diffuse abdominal pain and distension, low grade fever, massive ascites, and an increased serum CA 125 value. Computed tomography of the abdomen and pelvis and ultrasonography of the pelvis were suggestive of ovarian carcinoma. Exploratory laparotomy revealed massive ascites; diffuse peritoneal studding of numerous 1- to 2-mm implants in the bowel, omentum and abdominal wall; a cystic adnexal mass; and indurated head of the pancreas. Histopathological examination of several implants showed multiple epitheloid granulomata with rare central necrosis. The patient responded well to antituberculous therapy.

Elevated serum CA 125 and adnexal mass mimicking ovarian carcinoma in a patient with tuberculous peritonitis.

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Elevated serum CA 125 and adnexal mass mimicking ovarian carcinoma in a patient with tuberculous peritonitis.