Clinical and Laboratory Characteristics of Patients with Peritoneal Tuberculosis Mimicking Advanced Ovarian Cancer

CT texture analysis for differentiating between peritoneal carcinomatosis and peritoneal tuberculosis: a cross-sectional study

PURPOSE

Peritoneal carcinomatosis (PC) and peritoneal tuberculosis (PTB) have similar clinical and radiologic imaging features, which make it very difficult to differentiate between the two entities clinically. Our aim was to determine if the CT textural parameters of omental lesions among patients with PC were different from those with PTB.

METHODS

All patients who had undergone omental biopsy at our institution from January 2010 to December 2018 and had a tissue diagnosis of PC or PTB were eligible for inclusion. Patients who did not have a contrast-enhanced CT abdomen within one month of the omental biopsy were excluded. A region of interest (ROI) was manually drawn over omental lesions and radiomic features were extracted using open-source LIFEx software. Statistical analysis was performed to compare mean differences in CT texture parameters between the PC and PTB groups.

RESULTS

A total of 66 patients were included in the study of which 38 and 28 had PC and PTB, respectively. Omental lesions in patients with PC had higher mean radiodensity (mean difference: +32.4; p = 0.001), higher mean entropy (mean difference: +0.11; p < 0.001), and lower mean energy (mean difference: -0.024; p = 0.001) compared to those in PTB. Additionally, omental lesions in the PC group had lower gray-level co-occurrence matrix (GLCM) homogeneity (mean difference: -0.073; p < 0.001) and higher GLCM dissimilarity (mean difference: +0.480; p < 0.001) as compared to the PTB group.

CONCLUSION

CT texture parameters of omental lesions differed significantly between patients with PTB and those with PC, which may help clinicians in differentiating between the two entities.

Diagnostic value of serum CA125 combined with PET/CT in ovarian cancer and tuberculous peritonitis in female patients

PURPOSE

To evaluate the diagnostic value of serum CA125 combined with 18F-FDG PET/CT in ovarian cancer (OC) and tuberculous peritonitis (TBP) in female patients and to establish a diagnostic scoring system.

METHOD

A total of 86 female patients (64 OC and 22 TBP) were included in this study. Serum CA125, PET/CT maximal intensity projection (MIP), maximal standardized uptake value, ovarian mass, ascites volume, and other indicators were analyzed and a diagnostic scoring system was established according to the weights of statistically significant indicators.

RESULTS

Univariate analysis showed that serum CA125 in OC and TBP patients were 2079.9 ± 1651.3 U/mL and 448.3 ± 349.5 U/mL (P < 0.001). In MIP images, abdominal lesions were focal distribution in 92.2% (59/64) of OC patients and diffuse distribution in 95.5% (21/22) of TBP patients (P < 0.001). Ovarian masses could be observed in 82.8% (53/64) OC patients and 31.8% (7/22) TBP patients (P <0.001). The other indicators were not statistically significant. Logistic regression analysis showed that serum CA125 and MIP were independent risk factors for diagnosis. A diagnostic scoring system could be established based on serum CA125, MIP and ovarian mass, and the diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 98.4% (63/64), 95.5% (21/22), 97.7% (84/86), 98.4% (63/64), and 95.5% (21/22), respectively.

CONCLUSION

Serum CA125 combined with PET/CT is of great value in the diagnosis of OC and TBP. A simple and efficient diagnostic scoring system can be established using serum CA125, MIP image feature, and ovarian mass.

Encysted Peritoneal Tuberculosis Masquerading as Ovarian Tumour: A Case Report

Peritoneal tuberculosis (TB) is one of the types of extrapulmonary TB that predominantly involves the omentum, liver, intestinal tract, spleen, or female genital tract. It can occasionally result in gynecological-related oncology diagnoses such as advanced ovarian cancer due to its non-specific signs and symptoms, making it very difficult to detect. This report presents a case of a 22-year-old female who presented with the chief complaints of pain and distension of the abdomen for one month with dysuria. Ultrasonography and magnetic resonance imaging was performed that reported a large uni-loculated cystic pelvic abdominal lesion likely to be of ovarian origin and suggestive of neoplastic etiology with bilateral hydroureteronephrosis. To confirm the diagnosis, an exploratory laparotomy was performed which revealed extrapulmonary abdominal TB, and was registered for Directly Observed Treatment Shortcourse (DOTS) following which anti-tubercular drugs were given. In conclusion, this case report highlighted the masquerading behavior of encysted peritoneal TB as an ovarian tumor, and the fact that it should, therefore, should be considered in the differential diagnosis in regions where TB remains endemic, such as in developing countries. Hence, an appropriate diagnosis can prevent the need for unnecessary surgical operations and adequate therapy can save the patient's life.

Abdominal Tuberculosis Mimicking Ovarian Cancer: A Case Report and Review of the Literature

Introduction

Tuberculosis (TB) is a disease with high morbidity and mortality resulting from infection by Mycobacterium tuberculosis. TB can disseminate to any organ system of the body resulting in extrapulmonary tuberculosis. Interestingly, CA-125, which is a biomarker for some cancer, also rises in benign diseases such as pulmonary and extrapulmonary tuberculosis which may complicate diagnosis. In this case report, we present an abdominal tuberculosis patient that was initially presented as ovarian cancer.

Case Report

A 30-year-old woman admitted to the emergency department with chief complaint of fatigue and shortness of breath since 3 months ago. She had lost around 20 kg weight in the past 5 months. She was previously suspected with ovarian cancer because of the characteristic features of malignancy, high levels of CA-125, and positive PET scan. She was later diagnosed with abdominal TB. Subsequently, the patient was given anti-TB drugs, and the patient showed clinical improvement.

Conclusion

In the case of an elevated CA-125, clinicians should consider extrapulmonary TB as a differential diagnosis of ovarian cancer, especially in countries with high burden of tuberculosis.