Deciphering the diagnostic dilemma of abdominopelvic tuberculosis and advanced ovarian cancer

Anitha Gandhi, Sundaram Shanmugasundaram, Deepa Shunmugam

Abstract


Background: Abdominopelvic tuberculosis often poses a diagnostic challenge due to its bizarre clinical features and inconclusive imaging features. Most such patients were categorized under advanced ovarian cancer and undergo radical cytoreductive surgery with its associated morbidity, which would otherwise
resolve spontaneously with medical management.
Materials and Methods: This is a retrospective study of ten patients referred to the Department of Surgical Oncology between November 2015 to October 2018 in a tertiary care centre at south Tamil Nadu, India as advanced ovarian cancer and later diagnosed to have tuberculosis.
Results: In 10 patients, the mean age was 34 years; mean CA125 was 496.6 IU/ml. abdominal pain and distension, loss of weight were seen in 70% of cases, respectively. Only one patient had a prior history of tuberculosis. The imaging findings were complex adnexal mass in 9 patients (90%), ascites in 6 patients
(60%) and omental stranding in 6 patients (60%). Abdominal paracentesis was done in 6 patients (60%) and all had lymphocyte rich effusion. The diagnosis is established by laparotomy and biopsy in seven patients (70%), diagnostic laparoscopy in two patients (20%) and image-guided trucut biopsy in one patient (10%) with histopathology revealing caseating granulomas.
Conclusion: With our patients’ experience, a high index of suspicion is always needed whenever we encounter young women presenting with ascites, adnexal mass and elevated serum CA125 even when the routine investigations for tuberculosis reveal negative findings. The biopsy is the gold standard for
establishing the diagnosis and to commence therapy.

Keywords: peritoneal tuberculosis ascites, CA 125 abdominopelvic tuberculosis


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