Peritoneal Tuberculosis Mimicking Ovarian Cancer: A Report of Two Cases

Peritoneal tuberculosis (PTB) and ovarian cancer have overlapping nonspecific symptoms and signs. No pathognomonic clinical features or imaging findings can help to distinguish definite diagnosis of extra pulmonary TB. Peritoneal TB can be easily confused with peritoneal carcinomatosis or advanced ovarian carcinoma; therefore, it is difficult to distinguish these two entities. The current study described two cases of peritoneal tuberculosis mimicking advanced ovarian cancer.

In the first case, the initial manifestation was lower abdominal pain. The imaging indicated ovarian mass, ascites and hepatic surface nodularity, omental and peritoneal thickening. Also, titer of tumor marker CA-125 was more than 600 units. In laparoscopy, disseminated peritoneal seeding was observed. Frozen section of sampling these lesions reported tuberculosis. Biopsy of ovarian mass reported fibrothecoma. Concurrent with this patient, the second case referred to the same center, Department of Gynecology Oncology at Ghaem Hospital, Mashhad University, Iran, in 2015. Her presentation was fever and remarkable weight loss during the last three months. She had a multiloculated pelvic mass with septation in sonography and peritoneal seeding with pleural effusion in computed tomography (CT) scan. Peritoneal tuberculosis was recognized through laparotomy and both patients received anti-TB treatment and now they are in good health status.

Peritoneal tuberculosis should always be considered in differential diagnosis of patients with evidences suggesting advanced ovarian cancer.