GENITAL TUBERCULOSIS MIMICKING CARCINOMA OVARY: CAN ULTRASOUND GUIDED BIOPSY BE A RESOLUTION!
AbstractGenital tuberculosis mimicking carcinoma ovary is a well-known dilemma as there is no definitive serological or imaging modality for diagnosing abdominopelvic tuberculosis. A 20-years-old unmarried girl presented with complex adnexal mass, mild ascites and CA 125 >1000. Her staging laparotomy and frozen section was planned. Laparotomy revealed miliary tuberculosis and frozen section confirmed the diagnosis of tuberculosis. Patient was started with anti-tuberculosis treatment and follow up showed resolution of cysts. Another case is of 31 years old unmarried lady presented with history of abdominal pain. Her ultrasound revealed complex adnexal mass. CT scan revealed bilateral adnexal masses with solid and cystic lesion, ascites, para aortic lymphadenopathy; features suggestive of mitotic lesion. Her CA 125 was >1000. Family history of tuberculosis was positive. Keeping her age group and family history in view; workup of tuberculosis was performed. X ray chest was normal. Tuberculin skin test was 10mm and Quantiferon gold test was negative. In this case a decision of ultrasound guided biopsy was made. Result of biopsy showed granulomatous inflammation confirming pelvic tuberculosis. Ultrasound guided biopsy is a minimally invasive procedure with high diagnostic yield can be very helpful in such case. Clear guidelines should be developed nationally owing to the high prevalence of tuberculosis in our country to avoid unnecessary laparotomies.Keywords: Genital tuberculosis; Adnexal cyst; CA125; Ultrasound guided biopsy, Tuberculosis
WHO. Tuberculosis. Fact sheet N 104. Updated October 2015. 2016.
Jindal S, Shankar P, Raoof S, Gupta D. Textbook of Pulmonary and Critical Care Medicine. New Delhi: Jaypee Brothers Medical Publisher; 2011.
Skolnik R. Global health 101. 2nd ed. Jones & Bartlett Publishers; 2011.
Griffith D, Kerr C. Tuberculosis: disease of the past, disease of the present. J Perianesth Nurs 1996;11(4):240–5.
Sharma MP, Bhatia V. Abdominal tuberculosis. Indian J Med Res 2004;120(4):305–15.
Jana N, Mukhopadhyay S, Dhali GK. Pelvic tuberculosis with elevated serum CA125: a diagnostic dilemma. J Obstet Gynaecol 2007;27(2):217–8.
Barutcu O, Erel HE, Saygili E, Yildirim T, Torun D. Abdominopelvic tuberculosis simulating disseminated ovarian carcinoma with elevated CA-125 level: report of two cases. Abdom Imaging 2002;27(4):465–70.
Moss EL, Hollingworth J, Reynolds TM. The role of CA125 in clinical practice. J Clin Pathol 2005;58(3):308–12.
CDC. Guidelines for the investigation of contacts of persons with infectious tuberculosis: recommendations from the National Tuberculosis Controllers Association and CDC. MMWR Recomm Rep 2005;54(RR-15):1–47.
Uzunkoy A, Harma M, Harma M. Diagnosis of 16.abdominal tuberculosis: experience from 11 cases and review of the literature. World J Gastroenterol 2004;10(24):3647–9.
Foundation for Innovative New Diagnostics, Special Programme for Research and Training in Tropical Diseases, World Health Organization, editors. Diagnostics for tuberculosis: global demand and market potential. Geneva: WHO on behalf of the Special Programme for Research and Training in Tropical Diseases; 2006.
Vagenas K, Stratis C, Spyropoulos C, Spiliotis J, Petrochilos J, Kourea H, et al. Peritoneal carcinomaosis versus peritoneal tuberculosis: a rare diagnostic dilemma in ovarian masses. Cancer Ther 2005;3:489–94.
Oge T, Ozalp SS, Yalcin OT, Kabukcuoglu S, Kebapci M, Arik D, et al. Peritoneal tuberculosis mimicking ovarian cancer. Eur J Obstet Gynecol Reprod Biol 2012;162(1):105–8.
Devi L, Tandon R, Goel P, Huria A, Saha PK. Pelvic tuberculosis mimicking advanced ovarian malignancy. Trop Doct 2012;42(3):144–6.
Xi X, Shuang L, Dan W, Ting H, Han MY, Ying C, et al. Diagnostic dilemma of abdominopelvic tuberculosis:a series of 20 cases. J Cancer Res Clin Oncol 2010;136(12):1839–44.
Bhattacharyya SK, Mandal A, Thakur SB, Mukherjee S, Saha SK, Ghoshal AG. Radiological evaluation of chest in abdominal tuberculosis. J Clin Diagn Res 2011;5(5):926–28.
Le Thi HD, Mohattane H, Piette JC, Bogdan A, Auzeby A, Touitou Y, et al. Specificity of CA 125 tumor marker. A study of 328 cases of internal medicine. Presse Med 1988;17(43):2287–91.
Piura B, Rabinovich A, Leron E, Yanai-Inbar I, Mazor M. Peritoneal tuberculosis mimicking ovarian carcinoma with ascites and elevated serum CA-125: case report and review of literature. Eur J Gynaecol Oncol 2002;23(2):120–2.
Yassaee F, Farzaneh F. Familial tuberculosis. mimicking advanced ovarian cancer. Infect Dis Obstet Gynaecol 2009;736018.
Patel SM, Lahamge KK, Desai AD, Dave KS. Ovarian carcinoma or abdominal tuberculosis? -A diagnostic dilemma: study of fifteen cases. J Obstet Gynaecol India 2012;62(2):176–8.
Koc S, Beydilli G, Tulunay G, Ocalan R, Boran N, Ozgul N, et al. Peritoneal tuberculosis mimicking advanced ovarian cancer: A retrospective review of 22 cases. Gynecol Oncol 2006;103(2):565–9.
Heatley MK. A systematic review of papers examining the use of intraoperative frozen section in predicting the final diagnosis of ovarian lesions. Int J Gynecol Pathol 2012;31(2):111–5.
OgeT, Yalcin OT, Ozalp SS, Kebapci M, Aydin Y, Telli E. Sonographically guided core biopsy: a minimally invasive procedure for managing adnexal masses. J Ultrasound Med 2013;32(11):2023–7.
Thabet A, Somarouthu B, Oliva B, Gervais DA, Hahn PF, Lee SI. Image-guided ovarian mass biopsy: efficacy and safety. J Vasc Interv Radiol 2014;25(12):1922–7.