Abdominal Tuberculosis Mimicking Ovarian Cancer: A Diagnostic Dilemma

The objective of this study was to describe the clinicopathological details in patients referred to the Gynaecologic Oncology Department with possible ovarian or primary peritoneal cancer where the final diagnosis turned out to be abdominal tuberculosis.

Retrospective chart analysis of 23 cases diagnosed with abdominal tuberculosis who were admitted under the Division of Gynaecologic Oncology suspected to have disseminated peritoneal malignancy, during 2014-2017.

There were 23 patients who were referred to the Gynaecologic Oncology outpatient for evaluation of ascites, to rule out malignancy. The mean age of this patient group was 35 years (SD 14.5, range 14-65). The mean CA 125 was 333.5 [400.7 (9.09-1568)]. Ascitic fluid analysis confirmed TB in 26%; omental biopsy revealed TB in 69%, and operative diagnostic procedures (laparoscopy and laparotomy) were done in 15 of the 23 patients which had a positive pick up rate of 100% to confirm the diagnosis of TB. Culture of ascitic fluid/omental tissue and PCR yields were poor with a pick up rate of 33% and 6%.

Abdominal TB is common in India and can mimic ovarian malignancy, and hence, high degree of suspicion needed. The isolation of AFB is the gold standard for diagnosis of pulmonary tuberculosis but has a low yield in abdominal TB. Ultrasound-guided procedure is reasonable as an initial procedure. As much time can be lost in working up these patients through multiple diagnostic algorithms using ascitic tap, USG biopsy and then an operative procedure, diagnostic laparoscopy could be considered early in the work up. It is a simple, time-saving and cost-effective way of establishing a diagnosis sooner with least complications.