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Nonaka M, Ishida H, Manrai M, Takashima A. Tuberculous peritonitis diagnosed following laparoscopic examination for suspected advanced ovarian cancer. BMJ Case Rep 2024; 17:e257973. [PMID: 38429060 PMCID: PMC10910656 DOI: 10.1136/bcr-2023-257973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
Laparoscopy for intra-abdominal exploration and tissue sampling is useful in advanced ovarian cancers, in which it is presumed to be difficult to achieve complete tumour reduction in the initial surgery. This is a report of a case of suspected advanced ovarian cancer in a patient, who underwent laparoscopic screening and was later pathologically diagnosed with tuberculous peritonitis. A woman in her 50s visited her local doctor with constipation. Since imaging showed massive ascites she was referred for further evaluation. We initially suspected advanced ovarian cancer due to the presence of massive ascites and multiple peritoneal nodules. However, histopathological examination indicated that the nodules were tubercles, and the patient was subsequently diagnosed with tuberculous peritonitis. It is important to be aware that tuberculosis peritonitis can be misdiagnosed or mistaken for advanced ovarian cancer. Preoperative diagnosis of tuberculous peritonitis is often difficult. Tuberculous peritonitis should be considered if intraoperative findings show diffuse nodular disseminated lesions.
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Affiliation(s)
- Mizuki Nonaka
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura, Japan
| | - Hiroaki Ishida
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura, Japan
| | - Megumi Manrai
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura, Japan
| | - Akiko Takashima
- Department of Obstetrics and Gynecology, Toho University Medical Center, Sakura, Japan
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Engin G, Yirgin K, Kandemir H. Extrapulmonary Tuberculosis Mimics Diffuse Metastatic Disease: A Case Report. Indian J Radiol Imaging 2021; 31:1039-1042. [PMID: 35136525 PMCID: PMC8817791 DOI: 10.1055/s-0041-1739378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Extrapulmonary tuberculosis (TB) is associated with major diagnostic difficulties as it has many atypical symptoms and its imaging findings are similar to those of many other diseases.
Case Report
We present the case of a 50-year-old woman with a complex cystic mass in her pelvis and a 2-month history of pain. Thoracoabdominal computed tomography (CT) revealed the following: (1) multiple supraclavicular, axillary, mediastinal, and abdominal pathologic lymph nodes with central hypoattenuation; (2) sternal and dorsal vertebral bone destruction with a soft tissue mass; and (3) multiple hypoattenuating masses in the liver.
18
F-fludeoxyglucose positron emission tomography/computed tomography (
18
F-FDG PET/CT) revealed pathologic uptake in the defined areas, which were similar to metastases. Chest X-ray was normal. Diffuse metastatic disease was suspected clinically, but careful analysis of the imaging findings and the final pathologic results revealed multisystemic extrapulmonary TB. Clinical and radiological recovery was significant after anti-TB treatment at the 6-month follow-up.
Conclusion
Extrapulmonary TB without pulmonary involvement is associated with major diagnostic difficulties, especially with PET-CT. However, recognition and understanding of the CT or MR imaging spectrum can aid in the correct diagnosis and management of the disease.
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Affiliation(s)
- Gulgun Engin
- Department of Radiology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Kızıldag Yirgin
- Department of Radiology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Hulya Kandemir
- Department of Obstetrics and Gynecology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Capa, Turkey
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Maheshwari A, Gupta S, Rai S, Rekhi B, Kelkar R, Shylasree TS, Menon S, Deodhar K, Thakur M, Das U, Gupta S, Tandon S. Clinical and Laboratory Characteristics of Patients with Peritoneal Tuberculosis Mimicking Advanced Ovarian Cancer. South Asian J Cancer 2021; 10:102-106. [PMID: 34604126 PMCID: PMC8483894 DOI: 10.1055/s-0041-1736030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objectives Peritoneal tuberculosis can mimic advanced abdominal malignancy. We describe clinical and laboratory characteristics in a series of female patients with peritoneal tuberculosis who were referred to a tertiary cancer center with a diagnosis of suspected advanced ovarian/primary peritoneal cancer. Materials and Methods Details of clinical features, laboratory results including serum tumor markers, radiological findings, and ascitic fluid evaluation were retrospectively collected from hospital records for patients diagnosed to have peritoneal tuberculosis and reported descriptively. Statistical Analysis Descriptive statistics was performed using SPSS Statistics for Windows software, version 20.0 (SPSS, Chicago, Illinois). Results Between January 2009 and December 2017, 120 patients of peritoneal tuberculosis with a median age 41 years (range, 15-79 years) were identified. Of these 112 (93.3%; 95% CI 88.9-97.8%) patients had ascites and 63 (52.5%; 95% CI 43.6-61.4%) had adnexal mass at presentation. Mean serum cancer antigen 125 (CA-125) level was 666.9 (range, 38-18,554) U/mL. Ascitic fluid was negative for malignant cells in all patients and lymphocyte rich exudate was seen in 103 (91.9%; 86.9-97.0%) patients. Ascitic fluid adenosine deaminase (ADA) level was more than 40 U/L in 107 (95.5%; 95% CI 91.7-99.4%). Ascitic fluid Ziel-Neelsen staining was positive in 4/62 (6.5%; 95% CI 0.3-12.6%) patients while ascitic fluid culture examination for mycobacterium tuberculosis was positive in 7/59 (11.9%; 95% CI 3.6-20.1%) patients. The diagnosis of tuberculosis was based on image-guided biopsy in 44 (36.7%) patients, surgical biopsy in 8 (6.7%) patients, and a combination of clinicoradiological and laboratory features in 68 (56.7%) patients. All patients received standard antitubercular treatment. Conclusions The study results suggest that peritoneal tuberculosis has clinical, radiological, and serological profile which may mimic advanced ovarian/primary peritoneal cancer. Peritoneal tuberculosis should be considered in the differential diagnosis of advanced abdominal malignancy.
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Affiliation(s)
- Amita Maheshwari
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Deptartment of Medical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shweta Rai
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Deptartment of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rohini Kelkar
- Deptartment of Microbiology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - T S Shylasree
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Deptartment of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Deptartment of Pathology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Meenakshi Thakur
- Deptartment of Radiodiagnosis, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ushasree Das
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Stuti Gupta
- Department of Gynecologic Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandeep Tandon
- Department of Medicine, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Abstract
The role of hybrid imaging with 2-[18F] flourodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) is continuously evolving and now considered standard practice in evaluation of disease stage, treatment response, recurrent disease and follow-up for numerous primary malignancies. In gynecological malignancies FDG PET/CT plays an important role, not only in the assessment of disease in the pre-and post-therapy setting, but also in radiation therapy (RT) planning by defining the metabolically active gross tumor volume (GTV. The glucose analogue radiotracer, FDG, is by far the most utilized radiotracer in PET/CT and is typically seen with high uptake in malignant cells. The radiotracer FDG has a high sensitivity but low specificity for malignancy, as benign processes with an inflammatory response for example infection, are also FDG-avid. In the evaluation of the female pelvic region an awareness of potential confounding factors in the interpretation of FDG is essential as variations of FDG uptake occur in accordance with the menstrual cycle and the menopausal state. Incidental imaging findings in the female genital can pose differential diagnostic challenges as false-positive and false-negative findings in benign and malignant processes are not uncommon. Gynecological malignancies continue to pose major public health problems with cervical cancer as the fourth most common cancer in women ranking after breast cancer, colorectal cancer and lung cancer. Familiarity with frequently encountered benign and malignant variants and pitfalls in FDG PET/CT in the female pelvic region can aid the reader in differential diagnostic considerations.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
| | - Naja Liv Hansen
- Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Peritoneal Tuberculosis Mimicking Ovarian Cancer: Gynecologic Ultrasound Evaluation with Histopathological Confirmation. GASTROENTEROLOGY INSIGHTS 2021. [DOI: 10.3390/gastroent12020024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Peritoneal tuberculosis (TBP) is a very rare condition, accounting for about 1–2% of all tuberculosis cases. The diagnosis of TBP can be easily mistaken for advanced ovarian cancer (AOC) or peritoneal carcinoma because of overlapping laboratory and clinical findings. We reported the ultrasound characteristics of a case of TBP in a 67-year-old woman who presented to our institute with a 1-month history of intermittent lower abdominal pain, fever, and asthenia. Overall, 20 biopsy-retrieved specimen histopathological features were suggestive of peritoneal tuberculosis. Gynecologic ultrasound revealed increased adnexa with multiple nodular formations spread across the surface, suggestive of caseous nodules. Although this is a rare occurrence, clinicians should consider TBP as a differential diagnosis of ovarian or peritoneal cancer.
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Ahamed Z R, Shah J, Agarwala R, Kumar-M P, Mandavdhare HS, Gupta P, Singh H, Sharma A, Dutta U, Sharma V. Controversies in classification of peritoneal tuberculosis and a proposal for clinico-radiological classification. Expert Rev Anti Infect Ther 2019; 17:547-555. [PMID: 31293195 DOI: 10.1080/14787210.2019.1642746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Rizwan Ahamed Z
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Roshan Agarwala
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Drayer SM, Shank JJ. Infectious diseases mimicking ovarian carcinomatosis. Gynecol Oncol Rep 2018; 26:29-31. [PMID: 30211290 PMCID: PMC6129668 DOI: 10.1016/j.gore.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/14/2018] [Accepted: 08/27/2018] [Indexed: 11/24/2022] Open
Abstract
Infectious diseases can present similar to ovarian cancer and occur concomitantly with ovarian pathology. With increased worldwide travel and migration of populations, infections endemic to developing countries can emerge in the United States. We present 2 cases of infectious diseases mimicking ovarian carcinomatosis. Two Filipino women presented with abdominal distension and had evaluations suggestive of advanced gynecologic malignancy. The first patient underwent surgery and was found to have peritoneal tuberculosis. Intra-operative pathology from the second case revealed ovarian carcinoma with schistosomal granulomas of the intestines. Tuberculosis and schistosomiasis should be considered when treating women with gynecologic malignancies, especially those from abroad or who have spent time overseas. Correct identification of infectious etiologies allows for pharmacological intervention and can minimize unnecessary surgical procedures. Sporadic cases of tuberculosis and schistosomiasis have appeared in non-endemic regions due to global migration. Infectious diseases, such as pelvic tuberculosis, can have imaging findings suggestive of gynecologic malignancy. Recognition of infectious diseases allows for pharmacologic intervention and can minimize unnecessary surgical procedures.
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Affiliation(s)
- Sara M Drayer
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, CA, United States
| | - Jessica J Shank
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, CA, United States
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Abdominopelvic Tuberculosis Secondary to a Nontuberculous Mycobacterium in an Immunocompetent Patient. Case Rep Med 2017; 2017:9016782. [PMID: 29259630 PMCID: PMC5702933 DOI: 10.1155/2017/9016782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/21/2017] [Accepted: 10/12/2017] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis (TB) remained as one of the top 10 causes of death worldwide despite an overall decline in its incidence rate globally. Extrapulmonary TB is uncommon and only accounts for 10–20% of overall TB disease burden. Abdominopelvic TB is the sixth most common location of extrapulmonary TB. The symptoms and signs are often insidious and nonspecific. Diagnosing abdominopelvic TB can be very challenging at times and poses great difficulties to the clinician. Infection with nontuberculous Mycobacterium (NTM) is even rarer especially in an immunocompetent patient. We report a case of NTM in abdominopelvic TB. A 37-year-old foreign worker, para 3, presented with a one-week history of suprapubic pain associated with fever. An assessment showed presence of a right adnexal mass. She was treated as tuboovarian abscess with intravenous antibiotics. Unfortunately, she did not respond. She underwent exploratory laparotomy. Intraoperatively, features of the mass were suggestive of a right mature cystic teratoma with presence of slough and cheesy materials all over the abdominal cavity as well as presence of ascites. Diagnosis of NTM was confirmed with PCR testing using the peritoneal fluid. This case was a diagnostic dilemma due to the nonspecific clinical presentation. Management of such rare infection was revisited.
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9
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Rudelius M, Brehm K, Poelcher M, Spinner C, Rosenwald A, da Costa CP. First case of human peritoneal cysticercosis mimicking peritoneal carcinosis: necessity of laparoscopy and histologic assessment for the correct diagnosis. JMM Case Rep 2017; 4:e005097. [PMID: 29026624 PMCID: PMC5630966 DOI: 10.1099/jmmcr.0.005097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 05/03/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction. Correct diagnosis of peritoneal infectious disease can be extremely difficult due to non-specific clinical features. Thus, careful assessment with thorough histopathological work-up is essential. Here, we report the first case of human peritoneal cysticercosis mimicking peritoneal carcinosis. Case presentation. The patient presented with recurring ascites and a tumour in the Douglas cavity accompanied by elevated tumour markers. There were no signs of systemic infection. On laparoscopy, the tumour was resected completely. Histology revealed a granulomatous reaction and a diagnosis suspicious of tuberculosis was made. Only after additional sections, avital cestode-fragments were visible and Taenia martis DNA was detected. Further staging by computerized tomography scan of the lung and brain turned out negative and the patient recovered quickly. Conclusion. Laparoscopy and histopathological examination can be extremely helpful for correct diagnosis and management in uncertain recurrent ascites. This case clearly demonstrates that orphan infectious diseases should also be considered. Only complete histopathological examination with serial sections and additional molecular testing can lead to the appropriate diagnosis.
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Affiliation(s)
- Martina Rudelius
- Institute of Pathology, University of Wuerzburg and CCC Mainfranken, Josef-Schneider-Straße 2, 97080 Würzburg, Germany.,Institute of Pathology, University of Duesseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Klaus Brehm
- Institute of Pathology, University of Duesseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Martin Poelcher
- Institute of Hygiene and Microbiology, University of Wuerzburg, Josef-Schneiderstrasse 2, 97070 Würzburg, Germany.,Frauenklinik am Rotkreuzklinikum München, 80634 München, Germany
| | - Christoph Spinner
- Department of Medicine II, University Hospital Klinikum rechts der Isar, 81675 München, Germany
| | - Andreas Rosenwald
- Institute of Pathology, University of Wuerzburg and CCC Mainfranken, Josef-Schneider-Straße 2, 97080 Würzburg, Germany
| | - Clarissa Prazeres da Costa
- Institute of Medical Microbiology, Immunology and Hygiene, Technische Universität München (TUM), Ismaningerstrasse 25, 80333 München, Germany
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Abdominopelvic Tuberculosis with a Frozen Section Analysis Consistent with Ovarian Cancer. Case Rep Infect Dis 2017; 2017:6401694. [PMID: 28487789 PMCID: PMC5401731 DOI: 10.1155/2017/6401694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/09/2017] [Indexed: 11/18/2022] Open
Abstract
Pelvic tuberculosis is a type of extrapulmonary tuberculosis. The disease is accompanied by clinical and laboratory findings which may be unspecific and present aspects of other diseases, including gynecological malignancies. In this report, the authors presented a case of pelvic tuberculosis associated with peritoneal tuberculosis in a young woman exhibiting imaging and tumor markers consistent with ovarian neoplasm. An intraoperative frozen section analysis detected atypical cells that were suggestive of ovarian borderline or malignant epithelial neoplasia. The pathological analysis showed granulomatous inflammation in the right ovary and fallopian tube with a pattern of mycobacteriosis that was consistent with the presence of mycobacteria morphologically compatible with Mycobacterium tuberculosis. The patient had a complete remission after the use of antituberculosis drugs.
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Zhang L, Chen Y, Liu W, Wang K. Evaluating the clinical significances of serum HE4 with CA125 in peritoneal tuberculosis and epithelial ovarian cancer. Biomarkers 2015; 21:168-72. [DOI: 10.3109/1354750x.2015.1118552] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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12
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Affiliation(s)
- O Jolobe
- From the Department of Medicine, Manchester Medical Society, Manchester.
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Álvarez-Goris MDP, Ochoa Carrillo FJ, Sánchez Zamora R, Pérez-Calatayud ÁA, Torres Aguilar AA, Briones Garduño JC. Tuberculosis genital-peritoneal, la simuladora de cáncer de ovario. Reporte de un caso. GACETA MEXICANA DE ONCOLOGÍA 2015. [DOI: 10.1016/j.gamo.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Joob B, Wiwanitkit V. Pelvic inflammatory disease in China. Gynecol Obstet Invest 2014; 77:272. [PMID: 24851818 DOI: 10.1159/000362232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/14/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Beuy Joob
- Sanitation 1 Medical Academic Center, Bangkok, Thailand
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