Tuberculosis resembling a malignant tumour.
Tuberculosis (Care and treatment)
Carcinoma (Care and treatment)
Cancer (Care and treatment)
|Author:||Din, M. Afzal Ud|
|Publication:||Name: South African Journal of Surgery Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 South African Medical Association ISSN: 0038-2361|
|Issue:||Date: Feb, 2009 Source Volume: 47 Source Issue: 1|
|Geographic:||Geographic Scope: South Africa Geographic Code: 6SOUT South Africa|
To the Editor: A 21-year-old woman presented with a history of
abdominal pain, occasional vomiting, and fever of 2 weeks'
duration. She had no respiratory symptoms, and her past history was
unremarkable. On examination she had a low-grade fever and mild
tenderness in the abdomen. No masses were felt in the pelvis. Her white
cell count was 3.7 x [10.sup.9]/l, and blood culture was negative. The
chest radiograph was unremarkable. Computed tomography (CT) of the
abdomen showed a remarkable omental thickening, with nodularity with
ascites (Fig. 1). The level of the tumour marker CA-125 was 7 988 kU/l
(normal 0 - 35), and the level of carcino-embryonic antigen was normal.
At diagnostic laparoscopy, multiple seedlings were seen on the
peritoneum. Peritoneal biopsy was negative for malignancy, acid-fast
bacilli and Mycobacterium tuberculosis (MTB) complex DNA. The ascitic
fluid also was negative for MTB complex DNA and for malignant cells.
Histopathological examination of the peritoneal biopsy showed a chronic
inflammatory infiltrate resembling tuberculosis. The patient was put on
antituberculosis treatment, improved and was discharged.
[FIGURE 1 OMITTED]
Peritoneal tuberculosis may be misdiagnosed as peritoneal carcinomatosis, (1-3) as the two conditions share many radiological and clinical features, especially when serum CA-125 levels also are elevated. CA-125 is a useful marker of ovarian epithelial malignancy. It is secreted by mesothelial cells of the pleura, peritoneum and pericardium. Its levels can rise in conditions with serosal involvement by tuberculosis, (4) leukaemia and lymphoma. Acid-fast bacilli were not seen in the ascitic fluid and tissue specimen in our patient. The diagnosis was made by histopathology. This case reminds us that in any case of ascites with elevated serum CA-125 level tuberculosis should be considered in the differential diagnosis. It has been reported that CA-125 can be used to monitor the response to antituberculosis treatment. (5)
(1.) Groutz A, Carmon E, Gat A. Peritoneal tuberculosis and advanced ovarian cancer: a diagnostic dilemma. Obstet Gynecol 1998; 91: 868.
(2.) Rodriguez E, Pombo F. Peritoneal tuberculosis versus peritoneal carcinomatosis: distinction based on CT findings. J Comput Assist Tomogr 1996; 20: 269-272.
(3.) Mpiura B, Robinovitch A, Leron E, Yanai-Imbar I, Mazor M. Peritoneal tuberculosis--an uncommon disease that may deceive the gynaecologist. Eur J Gynaecol Oncol 2003; 110: 230-234.
(4.) Candocia SA, Locker GY. Elevated serum CA125 secondary to tuberculous peritonitis. Cancer 1993; 72: 2016-2018.
(5.) Mas MR, Comert B, Salamkaya U, et al. CA-125: a new marker for diagnosis and follow-up of patients with tuberculous peritonitis. Dig Liver Dis 2000; 32: 595-597.
M. Afzal Ud Din
Department of Surgery
King Fahd Medical City
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