Peritoneal tuberculosis in premenopausal patients with elevated serum CA 125

Area of Science:

• Medical Diagnostics
• Infectious Diseases
• Oncology

Background:

• Peritoneal tuberculosis (PTB) is a rare form of extrapulmonary tuberculosis.
• PTB can present with symptoms and imaging findings similar to advanced epithelial ovarian cancer.
• Elevated cancer antigen 125 (CA-125) levels are common in both PTB and ovarian cancer.

Purpose of the Study:

• To highlight the diagnostic challenge of differentiating peritoneal tuberculosis from advanced epithelial carcinoma.
• To emphasize the importance of considering PTB in patients with elevated CA-125 and suspected pelvic masses.

Main Methods:

• Retrospective review of pathology records from January 2000 to August 2008.
• Identification of patients with peritoneal caseating necrosis.
• Analysis of CA-125 levels in patients with PTB.

Main Results:

• Twenty-two patients were diagnosed with peritoneal caseating necrosis.
• Thirteen of these patients had elevated CA-125 levels.
• Eight patients with elevated CA-125 were diagnosed with PTB and received anti-tuberculosis therapy.

Conclusions:

• Elevated CA-125 levels in the context of suspected pelvic malignancy warrant careful evaluation for peritoneal tuberculosis.
• Preoperative frozen section evaluation is recommended if PTB is suspected.
• Aggressive surgical intervention should be approached cautiously, particularly in premenopausal women, to avoid unnecessary procedures.