Peritoneal tuberculosis in premenopausal patients with elevated serum CA 125

Peritoneal tuberculosis predominantly involves the omentum, intestinal tract, liver, spleen, and genitourinary tract and occurs in 1-4% of patients with pulmonary tuberculosis. Peritoneal tuberculosis may mimic a pelvic mass in imaging studies and also may increase CA-125 levels. Peritoneal tuberculosis may also produce massive ascites, and intraperitoneal gross appearance might be similar to the peritoneal carcinomatosis. Therefore, peritoneal tuberculosis is often confused with advanced-stage epithelial carcinoma because of similar clinical, radiologic, and laboratory findings and later intraoperative findings.

The pathology records between January 2000 and August 2008 were retrospectively reviewed at 19 Mayis University Hospital. Twenty-two patients were found to have peritoneal caseating necrosis. A total of 13 out of 22 patients were found to have high CA 125 level.

Among these 13 patients, 8 patients received/are receiving anti-tuberculous therapy after they were incidentally diagnosed with peritoneal tuberculosis.

Increased CA 125 levels should be evaluated carefully prior to aggressive surgical approach, especially in premenopausal women and frozen section evaluation should be done before extensive surgical procedure if there is any suspicion.