Journal of Cancer Research and Clinical Oncology

, Volume 136, Issue 12, pp 1839–1844

Diagnostic dilemma of abdominopelvic tuberculosis:a series of 20 cases

  • Xia Xi
  • Li Shuang
  • Wang Dan
  • Hu Ting
  • Meng Yu Han
  • Cao Ying
  • Mei Quan
  • Sun ChaoYang
  • Chen ZhiLan
  • Feng Cui
  • Cao Ming
  • Jian Feng Zhou
  • Wang Shi Xuan
  • Yun Ping Lu
  • Ding Ma
Original Paper

Abstract

Objective

To establish more effective diagnostic procedures to identify the characteristic features of abdominopelvic tuberculosis (APTB) mimicking advanced ovarian cancer.

Methods

A retrospective review of 20 cases of APTB mimicking advanced ovarian cancer was undertaken.

Results

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.

Conclusion

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.

Keywords

Abdominopelvic tuberculosis Ovarian cancer Diagnosis Laparotomy Frozen section 

References

  1. Barutcu O, Erel HE, Saygili E, Yildirim T, Torun D (2002) Abdominopelvic tuberculosis simulating disseminated ovarian carcinoma with elevated CA-125 level: report of two cases. Abdom Imaging 27:465–470CrossRefPubMedGoogle Scholar
  2. Bhansali SK (1977) Abdominal tuberculosis. Am J Gastroenterol 67:324–327PubMedGoogle Scholar
  3. Bolukbas C, Bolukbas FF, Kendir T, Dalay RA, Akbayir N, Sokmen MH, Ince AT, Guran M, Ceylan E, Kilic G, Ovunc O (2005) Clinical presentation of abdominal tuberculosis in HIV seronegative adults. BMC Gastroenterol 5:21CrossRefPubMedGoogle Scholar
  4. Gleeson NC, Nicosia SV, Mark JE, Hoffman MS, Cavanagh D (1993) Abdominal wall metastases from ovarian cancer after laparoscopy. Am J Obstet Gynecol 169:522–523PubMedGoogle Scholar
  5. Groutz A, Carmon E, Gat A (1998) Peritoneal tuberculosis versus advanced ovarian cancer: a diagnostic dilemma. Obstet Gynecol 91:868CrossRefPubMedGoogle Scholar
  6. Karlan BY, Platt LD (1995) Ovarian cancer screening. The role of ultrasound in early detection. Cancer 76:2011–2015CrossRefPubMedGoogle Scholar
  7. Koc S, Beydilli G, Tulunay G et al (2006) Peritoneal tuberculosis mimicking advanced ovarian cancer: a retrospective review of 22 cases. Gynecol Oncol 103:565–569CrossRefPubMedGoogle Scholar
  8. Kruitwagen RF, Swinkels BM, Keyser KG, Doesburg WH, Schijf CP (1996) Incidence and effect on survival of abdominal wall metastases at trocar or puncture sites following laparoscopy or paracentesis in women with ovarian cancer. Gynecol Oncol 60:233–237CrossRefPubMedGoogle Scholar
  9. Lantheaume S, Soler S, Issartel B, Isch JF, Lacassin F, Rougier Y, Tabaste JL (2003) Peritoneal tuberculosis simulating advanced ovarian carcinoma: a case report. Gynecol Obstet Fertil 31:624–626CrossRefPubMedGoogle Scholar
  10. Marshall JB (1993) Tuberculosis of the gastrointestinal tract and peritoneum. Am J Gastroenterol 88:989–999PubMedGoogle Scholar
  11. Miranda P, Jacops AJ, Roseff L (1996) Pelvic tuberculosis presenting as an asymptomatic pelvic mass with rising serum CA-125 levels: a case report. J Reprod Med 41:273–275PubMedGoogle Scholar
  12. Muneef MA, Memish Z, Mahmoud SA, Sadoon SA, Bannatyne R, Khan Y (2001) Tuberculosis in the belly: a review of forty-six cases involving the gastrointestinal tract and peritoneum. Scand J Gastroenterol 36:528–532CrossRefPubMedGoogle Scholar
  13. Nistal de Paz F, Herrero Fernandez B, Perez Simon R et al (1996) Pelvic-peritoneal tuberculosis simulating ovarian carcinoma: report of three cases with elevation of the CA125. Am J Gastroenterol 91:1600–1601Google Scholar
  14. Panoskaltsis TA, Moore DA, Haidopoulos DA et al (2000) Tuberculous peritonitis: part of the differential diagnosis in ovarian cancer. Am J Obstet Gynecol 182:740–742CrossRefPubMedGoogle Scholar
  15. Penna L, Manyonda Y, Amias A (1993) Intraabdominal miliary tuberculosis presenting as disseminated ovarian carcinoma with ascites and raised CA-125. Br J Obstet Gynaecol 100:51–53Google Scholar
  16. Phyo P, Mantis JA, Rosner F (2001) Elevated serum CA125 and adnexal mass mimicking ovarian carcinoma in a patient with tuberculous peritonitis. Prim Care Update Ob/Gyns 8(3):110–115CrossRefGoogle Scholar
  17. Piura B, Rabinovich A, Leron E, Yanai-Inbar I, Mazor M (2003) Peritoneal tuberculosis-an uncommon disease that may deceive the gynecologist. Eur J Obstet Gynecol Reprod Biol 110:230–234CrossRefPubMedGoogle Scholar
  18. Sheer TA, Coyle WJ (2003) Gastrointestinal tuberculosis. Curr Gastroenterol Rep 5:273–278CrossRefPubMedGoogle Scholar
  19. Sheth SS (1996) Elevated CA 125 in advanced abdominal or pelvic tuberculosis. Int J Gynecol Obstet 52:167–171CrossRefGoogle Scholar
  20. Thakur V, Mukherjee U, Kumar K (2001) Elevated serum cancer antigen 125 levels in advanced abdominal tuberculosis. Med Oncol 18:289–291CrossRefPubMedGoogle Scholar
  21. Uzunkoy A, Harma M, Harma M (2004) Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J Gastroenterol 10(24):3549–3647Google Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Xia Xi
    • 1
  • Li Shuang
    • 1
  • Wang Dan
    • 1
  • Hu Ting
    • 1
  • Meng Yu Han
    • 1
  • Cao Ying
    • 1
  • Mei Quan
    • 1
  • Sun ChaoYang
    • 1
  • Chen ZhiLan
    • 1
  • Feng Cui
    • 1
  • Cao Ming
    • 1
  • Jian Feng Zhou
    • 1
  • Wang Shi Xuan
    • 1
  • Yun Ping Lu
    • 1
  • Ding Ma
    • 1
  1. 1.Cancer Biology Research Center, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China

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