Abdominal Tuberculosis Simulating Advanced Ovarian Cancer: A Diagnostic Dilemma

Abstract

Background: The rate of preoperative misdiagnosis between abdominal tuberculosis and ovarian cancer is high because the symptoms are non-specific, clinical findings can be misleading, and biomarkers commonly linked with other diseases also make appropriate diagnosis difficult. Objective: To evaluate the clinical and diagnostic features in women with abdominal tuberculosis that simulated advanced ovarian malignancy. Materials and Methods: A retrospective review of 11 cases of abdominal tuberculosis managed at the Gynaecological Oncology unit of the University of Port Harcourt Teaching Hospital with suspected advanced ovarian cancer between January 1, 2016, and December 31, 2021. Clinical characteristics, laboratory results, including serum tumour markers, radiological findings, and ascitic fluid evaluation were extracted from theatre records and case notes and entered into a proforma. SPSS 25 was used for data analysis, and the results are displayed as frequency tables. Results: More than half 6 (55%) of the cases of abdominal TB were found in patients aged 20 to 40 years, with many patients 8 (72.7%) being nulliparous. Abdominal distension, Abdominal pain, and weight loss were the most common presenting symptoms. All patients had clinical evidence of ascites, along with thickening or ill-defined nodularities in the pouch of Douglas and/or in the adnexal areas on pelvic examination. Serum CA-125 levels were elevated in all 11 patients (100%), with a mean value of 327.8 U/mL. Pleural effusion and increased infiltration were seen in 5 (45.5%) patients. Ultrasound scan and computed tomography studies showed ascites in all 11 (100%) patients. Debritic ascites with peritoneal thickening, mesenteric and omental stranding were observed in all 11 patients (100%), and all 11 (100%) patients had laparotomy. All patients received standard antitubercular therapy. Conclusion:  In relatively young females with nonspecific symptoms, a diagnosis of abdominal TB should be considered. Ultrasound-guided biopsy, laparoscopy, or a mini-laparotomy may be the most direct and least-invasive approach for a diagnosis, avoiding unnecessary extended surgeries in these patients.