Pelvic Tuberculosis Simulating Advanced Ovarian Malignancy

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Abstract

Objective:

The objective of this study was to evaluate the women with peritoneal tuberculosis mimicking the advanced ovarian malignancy.

Methods:

The records of 9 women with peritoneal tuberculosis who were treated at the Kartal Research and Education Hospital between January 1999 and December 2003 were reviewed.

Results:

Patients were referred to our clinic because of abdominal swelling, pelvic–abdominal pain, anorexia, weight loss, subfebrile fever, sweating, and menstrual irregularity. Pelvic ultrasonography showed the presence of ascites and adnexal mass in 5 patients, only ascites in 3 patients, and only adnexal mass in one patient. Five patients underwent abdominopelvic computed tomography and the findings initially suggested malignancy. All patients had elevated serum CA-125 levels. The CA15-3 levels were measured in 8 patients and were also found to be elevated. Abdominal paracentesis was performed in 8 cases and revealed clear exudative fluid with benign cells. A clinical suspicion of primary ovarian carcinoma led to laparotomy in all patients and resulted with the diagnosis of tuberculosis. Frozen section examinations revealed the presence of tuberculosis in all patients. All patients underwent conservative surgery and were postoperatively treated with antituberculosis chemotherapy.

Conclusions:

Peritoneal tuberculosis is often misdiagnosed as advanced ovarian carcinoma. The clinical findings, Mantoux test, chest radiogram, and direct preparation from the abdominal paracentesis are not useful for differential diagnosis. Serum CA-125 and CA 15-3 levels may be useful in the follow up of patients. If no malignancy is detected and the diagnosis of peritoneal tuberculosis is confirmed, unnecessary extended surgery should be avoided and the antituberculosis treatment must be started.

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