Deciphering the diagnostic dilemma of abdominopelvic tuberculosis and advanced ovarian cancer

Background: Abdominopelvic tuberculosis often poses a diagnostic challenge due to its bizarre clinical features and inconclusive imaging features. Most such patients were categorized under advanced ovarian cancer and undergo radical cytoreductive surgery with its associated morbidity, which would otherwise resolve spontaneously with medical management.Materials and Methods: This is a retrospective study of ten patients referred to the Department of Surgical Oncology between November 2015 to October 2018 in a tertiary care centre at south Tamil Nadu, India as advanced ovarian cancer and later diagnosed to have tuberculosis.Results: In 10 patients, the mean age was 34 years; mean CA125 was 496.6 IU/ml. abdominal pain and distension, loss of weight were seen in 70% of cases, respectively.Only one patient had a prior history of tuberculosis. The imaging findings were complex adnexal mass in 9 patients (90%), ascites in 6 patients (60%) and omental stranding in 6 patients (60%). Abdominal paracentesis was done in 6 patients (60%) and all had lymphocyte rich effusion. The diagnosis is established by laparotomy and biopsy in seven patients (70%), diagnostic laparoscopy in two patients (20%) and image-guided trucut biopsy in one patient (10%) with histopathology revealing caseating granulomas.