Peritoneal tuberculosis with elevated CA-125 mimicking ovarian cancer with carcinomatosis peritonei: Crucial CT findings

Abstract

Preoperative diagnosis of peritoneal tuberculosis is often difficult because of confusion with ovarian cancer. A 56-year-old woman was admitted to our hospital with abdominal fullness. Ascites, prominent bilateral ovaries, and elevated CA-125 were noted. Computed tomography showed thickened peritoneum and strandings in the mesentery and omentum. Exploratory laparotomy was performed under the provisional diagnosis of ovarian cancer, but the final diagnosis was peritoneal tuberculosis. Careful evaluation of bilateral fallopian tubes and ovaries and peritoneum are helpful for correct diagnosis.

Keywords: carcinomatosis peritonei; computed tomography (CT); ovarian cancer; peritoneum; tuberculosis.

Figure 1. 56-year-old woman had suffered from abdominal fullness for three months.

(A) Axial contrast-enhanced abdominopelvic CT scan shows a uniform well-enhanced peritoneum (black arrow), and bilateral dilated convoluted fallopian tubes with intense mucosal enhancement (white arrow) representing bilateral salpingitis; these findings combined with dirty fat strandings identify infection. (B) Axial contrast-enhanced CT scan shows the nodules of the omentum (black arrow) and loculated ascites (white arrow). (C) Coronal contrast-enhanced CT scan demonstrates the disproportionate left ovarian mass (arrow) with loculated ascites, in contrast to the usual findings of ovarian cancer.

Figure 2. Photograph of histological specimen. (A) Hematoxylin and eosin stain shows the caseous necrosis (long arrow) and Langhans giant cell (short arrow) confirming tuberculosis peritonitis. (B) Acid-fast stain shows the tubercle bacilli (red circle)