Ovarian carcinoma and peritoneal tuberculosis: A rare coexistence with challenging diagnosis, a case report and literature review

Abstract

Peritoneal tuberculosis is one of the most challenging forms of extrapulmonary tuberculosis to diagnose, especially, in women as it often mimics an advanced ovarian carcinoma. Many authors had documented cases where peritoneal tuberculosis was initially misdiagnosed as advanced ovarian carcinoma, but only four cases had reported the coexistence of both conditions. We present the fifth case in the literature of concurrent peritoneal tuberculosis and serous cystadenocarcinoma of the ovary. A 61-year-old female patient presented with diffuse abdominal tenderness. Physical examination revealed an abdominal distension. Computed tomography scan showed a heterogeneous, poorly defined right latero-uterine mass associated with ascites and nodular peritoneal infiltration. The level of cancer antigen 125 was elevated. Therefore, a diagnosis of advanced ovarian carcinoma was highly suspected. A diagnostic laparoscopy was performed. Peritoneal biopsy confirmed the diagnosis of peritoneal tuberculosis without any histological evidence of malignancy. The patient subsequently underwent a right adnexectomy, which revealed serous cystadenocarcinoma of the ovary. She received 6 months of antituberculosis treatment complicated with renal dysfunction. Computed tomography scan control showed no abnormalities. Tumor markers levels decreased to the normal range. The patient refused further surgery and chemotherapy was recommended. Female patients presenting with ascites, adnexal masses, and elevated levels of cancer antigen 125 are usually presumed to have advanced ovarian carcinoma. There are a few discriminating features that suggest the diagnosis of peritoneal tuberculosis rather than peritoneal carcinomatosis of an advanced ovarian carcinoma. Eventually, their coexistence should be considered as a differential diagnosis, particularly in developing countries where tuberculosis is still endemic as it is the case of Tunisia.

Keywords: case report; ovarian cancer; peritoneal tuberculosis; serous cystadenocarcinoma.

Figure 1.

Intraoperative image showing peritoneal nodules.

Figure 2.

Right adnexectomy specimen.