Peritoneal Tuberculosis - Simulating Ovarian Cancer

2/24/2003

Question: Is abdominal tuberculosis characterized by elevated CA 125 levels and other signs and symptoms typical of ovarian cancer?

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Unique Identifier:12013106

Authors: Piura B. Rabinovich A. Leron E. Yanai-Inbar I. Mazor M.

Institution: Unit of Gynecologic Oncology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Title: Peritoneal tuberculosis mimicking ovarian carcinoma with ascites and elevated serum CA-125: case report and review of literature. [Review] [11 refs]

Source: European Journal of Gynaecological Oncology. 23(2):120-2, 2002.

Abstract: Peritoneal tuberculosis is rare in the western world, although its incidence has been increasing in recent years. The presenting signs and symptoms, imaging examinations and CA-125 status in peritoneal tuberculosis may resemble that of ovarian carcinoma. Thus, the possibility of peritoneal tuberculosis should be considered in the differential diagnosis of ovarian carcinoma, especially in women immigrants from countries with a high prevalence of tuberculosis. A case of peritoneal tuberculosis mimicking ovarian carcinoma in a young woman immigrant from India is described. The patient presented with ascites, abdominopelvic masses and elevated serum CA-125 (1,081 U/ml). Laparoscopy confirmed the diagnosis of peritoneal tuberculosis and no malignancy, and thereby unnecessary extended surgery was avoided. Following treatment with the 4-drug anti-tuberculosis regimen, the patient recovered with disappearance of ascites and abdominopelvic masses, and return of CA-125 to normal range. It is concluded that laparoscopy, if feasible, seems to be a sufficient and safe method to provide diagnosis of peritoneal tuberculosis. [References: 11] CAS Registry/EC Number 0 (Antibiotics, Antitubercular). 0 (CA-125 Antigen).

 Link Directly to Fulltext Article at Science Direct

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Unique Identifier:11748996

Authors: Mahdavi A. Malviya VK. Herschman BR.

Institution: Department of Obstetrics and Gynecology, Providence Hospital and Medical Centers, 16001 West Nine Mile Road, Southfield, Michigan 48075, USA. amahdavi@prodigy.net

Title: Peritoneal tuberculosis disguised as ovarian cancer: an emerging clinical challenge.

Source: Gynecologic Oncology. 84(1):167-70, 2002 Jan.

Abstract: BACKGROUND: The incidence of peritoneal tuberculosis in the western world has increased over the past decade. The diagnosis is often made at laparotomy for suspected peritoneal carcinomatosis. CASE: A 56-year-old Filipino female underwent exploratory laparotomy for suspected ovarian cancer. Frozen-section analysis of her ovaries revealed noncaseating granuloma and the initial acid-fast stains were negative, consistent with non-tuberculous granulomatous disease. Later, all specimen cultures grew Mycobacterium tuberculosis. CONCLUSION: The diagnosis of peritoneal tuberculosis can be difficult and elusive. It mimics ovarian cancer and non-tuberculous granulomatous diseases by its vague symptoms and nonspecific radiographic, pathologic, and laboratory findings. In patients at high risk for peritoneal tuberculosis, we emphasize the importance of clinical suspicion in addition to frozen-section analysis to avoid unnecessary extensive surgery and delay in anti-tuberculous treatment.

 Fulltext Available in EBSCO using ACADEMIC SEARCH PREMIER and the search term: (AN 9708272143)

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Unique Identifier:11520367

Authors: Bilgin T. Karabay A. Dolar E. Develio?lu OH.

Institution: Department of Obstetrics and Gynecology, Uluda? University, Faculty of Medicine, Bursa, Turkey. tbilgin@uludag.edu.tr

Title: Peritoneal tuberculosis with pelvic abdominal mass, ascites and elevated CA 125 mimicking advanced ovarian carcinoma: a series of 10 cases.

Source: International Journal of Gynecological Cancer. 11(4):290-4, 2001 Jul-Aug.

Abstract: Ten patients with peritoneal tuberculosis who were operated on for suspected advanced ovarian cancer during a 5-year period were analyzed. These 10 cases constituted 1.4% of the 728 new gynecologic cancer cases diagnosed and treated at our department during the same time period. Data were obtained from patients' files and pathology reports. The mean age of cases was 40.6 +/- 6.1 (median 37; range 18-72). Ascites was present together with ill-defined nodularities or thickening in the Douglas pouch and/or in the adnexal areas on pelvic examination in all patients but three, who presented with well-demarcated adnexal masses of about 5 cm in diameter. All patients had elevated serum CA 125 levels with a median of 331 U/ml, (40-560 U/ml). Ultrasound and abdominopelvic CT examinations revealed omental and mesenteric thickening in addition to ascites in all patients, cystic ovarian masses or ovarian enlargement in five, and peritoneal implants in two. Abdominal paracentesis performed in the six cases in whom the findings were felt to be most inconclusive for the diagnosis of ovarian cancer revealed clear exudative fluid with benign cells. Mycobacteria could not be demonstrated on direct preparations. Tuberculosis was diagnosed at laparotomy in all. Patients received antituberculous therapy and serum CA 125 levels returned to normal within 2 months after the beginning of treatment. This case series demonstrates a high rate of misdiagnosis between advanced ovarian cancer and peritoneal tuberculosis. Whereas abdominal paracentesis is useless in ruling out peritoneal tuberculosis, and serum CA 125 levels are not helpful in the differential diagnosis, the latter marker may be useful in the follow-up of patients. CAS Registry/EC Number 0 (CA-125 Antigen).

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Unique Identifier:11142557

Authors: Mas MR. Comert B. Sa?lamkaya U. Yamanel L. Kuzhan O. Ate?kan U. Kocabalkan F.

Institution: Department of Internal Medicine, Gulhane School of Medicine, Etlik, Ankara, Turkey. refikmas@yahoo.com

Title: CA-125; a new marker for diagnosis and follow-up of patients with tuberculous peritonitis.

Source: Digestive & Liver Disease. 32(7):595-7, 2000 Oct.

Abstract: BACKGROUND: Most malignancies with peritoneal infiltration, especially ovarian cancers and chronic liver diseases associated with ascites give rise to high serum CA-125 levels. Tuberculous peritonitis is another cause for high serum CA-125 levels. AIM: To investigate the relation between serum CA-125 level and response to treatment in tuberculous peritonitis patients. PATIENTS: Ten patients with tuberculous peritonitis were enrolled in the study. METHOD: Definite diagnosis of tuberculous peritonitis was made by acid-fast smears, specific culture, and polymerase chain reaction. Serum CA-125 levels were measured before and at the fourth month of treatment. RESULTS: Before antituberculous treatment, serum CA-125 levels of all patients were very high (mean+/-SD: 475. 80+/-106. 19 U/ml) and comparable with those of patients with ovarian cancers. At the end of the fourth month of treatment, serum CA-125 levels in all patients decreased to within normal limits (<35 U/ml)(20.80:+/-5.18 U/ml) in parallel with the clinical improvement. The differences in CA125 levels before and after treatment were statistically significant (p<0.001). CONCLUSIONS: Results of our study suggest that serum CA-125 levels in patients with tuberculous peritonitis are as high as ovarian cancers associated with peritoneal infiltration. By the end of the fourth month of antituberculous therapy, serum CA-125 levels have returned to normal. We, therefore, suggest that serum CA-125 can be used to evaluate the efficacy of therapy in tuberculous peritonitis. CAS Registry/EC Number 0 (Antitubercular Agents). 0 (Biological Markers). 0 (CA-125 Antigen).

 Fulltext Available in MDConsult using Journal Search and the search term: 9219793

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Unique Identifier:9219793

Authors: Simsek H. Savas MC. Kadayifci A. Tatar G.

Institution: Department of Internal Medicine, Hacettepe University Medical School, Ankara, Turkey.

Title: Elevated serum CA 125 concentration in patients with tuberculous peritonitis: a case-control study.

Source: American Journal of Gastroenterology. 92(7):1174-6, 1997 Jul.

Abstract: OBJECTIVES: High serum cancer antigen (CA) 125 levels have been shown to be present in patients with ovarian carcinoma, nongynecological cancers, and some benign diseases and have been used as a useful marker for monitoring patients with epithelial ovarian cancer. Although tuberculous peritonitis with elevated serum CA 125 levels is an important diagnostic problem because it may lead to misdiagnosis as ovarian carcinoma and unnecessary laparatomies, the levels of CA 125 in patients with tuberculous peritonitis has not been studied in detail. METHODS: Serum CA 125 levels in 11 consecutive patients (2 males, 9 females) with tuberculous peritonitis admitted to Hacettepe University and 20 healthy adult controls (7 males, 13 females) were studied. RESULTS: Serum CA 125 levels were found to be elevated in all patients with tuberculous peritonitis. The mean level in the study group was 316.6 IU/ml, whereas the level was 13.8 IU/ml in the control group (p < 0.0001). Serum CA 125 normalization showed a very close correlation with the response to antituberculous therapy. CONCLUSIONS: Tuberculous peritonitis must be considered in a differential diagnosis of patients with elevated serum CA 125 concentration. Correct diagnosis may prevent unnecessary laparatomies performed under the assumption of ovarian carcinoma, because it is cured completely by antituberculous therapy. Serum CA 125 level might be used as an effective marker in the diagnosis and follow-up of patients with tuberculous peritonitis. CAS Registry/EC Number 0 (Biological Markers). 0 (CA-125 Antigen).

Link Directly to Fulltext article in Ovid

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Unique Identifier:7883234

Authors: O'Riordan DK. Deery A. Dorman A. Epstein OE.

Institution: Department of Medicine, Royal Free Hospital, London.

Title: Increased CA 125 in a patient with tuberculous peritonitis: case report and review of published works.[comment]. [Review] [22 refs]

Source: Gut. 36(2):303-5, 1995 Feb.

Abstract: A case of a middle aged woman with weight loss, ascites, and a pleural effusion is presented where a clinical diagnosis of ovarian cancer was made. Her CA 125 was greatly increased at 873 IU/ml and the ascites was a lymphocytic exudate but cytology failed to show malignant cells. Operative biopsy showed numerous noncaseating granulomas in the omentum but no mycobacterial organisms were seen. Empiric antituberculous treatment was started before positive culture results were received and when treatment had ended both the ascites and pleural effusion had resolved and the CA 125 had fallen to 7 IU/ml. Review of published works showed several other examples of tuberculous peritonitis associated with increased CA 125 and the possible cause of raised CA 125 in this condition is discussed. [References: 22] CAS Registry/EC Number 0 (CA-125 Antigen).