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Pelvic-Peritoneal Tuberculosis Mimicking Ovarian Cancer
Pelvic-Peritoneal Tuberculosis Mimicking Ovarian Cancer
Pelvic-Peritoneal Tuberculosis Mimicking Ovarian Cancer
ABSTRACT
Pelvic-peritoneal tuberculosis is a common extrapulmonary site in young females mimicking an advanced ovarian
malignancy. We present 2 cases with the classical triad of advanced-stage ovarian carcinoma-ascites, abdominopelvic
masses and elevated serum CA-125 levels. Laparoscopic examination revealed peritoneal nodules which on biopsy
showed granulomatous inflammation and no malignant cells. Patients were started on anti-tuberculous therapy and on
follow-up their symptoms as well as CA-125 levels normalized. Medical awareness of peritoneal tuberculosis is lacking
and many young women with this disease undergo unnecessary extended surgery. Diagnostic laparoscopy combined with
peritoneal biopsy seems to be a sufficient and safe method to provide a definitive diagnosis for this curable infection. If left
untreated, the disease may disseminate and result in significant organ dysfunctions particularly infertility.
Journal of the College of Physicians and Surgeons Pakistan 2012, Vol. 22 (2): 113-115 113
Saba Imtiaz, Neelam Siddiqui, Murtaza Ahmad and Amna Jahan
114 Journal of the College of Physicians and Surgeons Pakistan 2012, Vol. 22 (2): 113-115
Pelvic-peritoneal tuberculosis mimicking ovarian cancer
the peritoneum, bowel loops were matted together and definitive diagnosis can be established in 80-94%
right adnexal mass was difficult to separate from the cases. The sensitivity of peritoneal biopsy by laparo-
right ovary. Peritoneal biopsies were submitted for scopy may reach upto 100%.8 Other methods like DNA
histopathology which showed necrotizing granulo- extraction by PCR or ELI spot (enzyme linked
matous inflammation (Figures 4a and 4b). Ziehl Neelson immunospot) on the frozen section specimens obtained
and GMS stains were negative. Patient was started on by laparoscopy can be helpful, but time and cost
ATT and the culture reports confirmed MTB after 8 consuming.4
weeks. Patient to-date is doing well and has regained In the past decades, numerous pelvic peritoneal
her weight and energy. tuberculoses cases were misdiagnosed as advanced
ovarian cancer and young females were un-necessarily
DISCUSSION subjected to extensive surgery.7,9 There is enough data
The clinical triad of abdominal pain, ascites and adnexal to change the clinical approach to a safer, rapid and
mass along with raised CA-125 levels in young women sufficient mode of diagnostic modality for the treatment
should raise the suspicion of pelvic tuberculosis of a curable infectious disease.
especially in countries with high prevalence. Consi-
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Journal of the College of Physicians and Surgeons Pakistan 2012, Vol. 22 (2): 113-115 115