Peritoneal tuberculosis disguised as ovarian cancer: an emerging clinical challenge

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.