Intra-abdominal tuberculosis masquerading as ovarian carcinoma

Abstract Intra-abdominal tuberculosis (TB) is rare in Australia, but it can be found in those who emigrate from endemic areas. We report a rare case of a 28-year-old lady from the Philippines who presented with abdominal pain, ascites and an elevated cancer antigen (CA) 125 with an initial concern of ovarian malignancy. She underwent a diagnostic laparoscopy which revealed typical features of intra-abdominal TB and histological features of granulomatous inflammation. The symptoms and signs of intra-abdominal TB are non-specific and can mimic many other conditions. The gold-standard mode of diagnosis in intra-abdominal TB is laparoscopy with tissue biopsy. Ovarian malignancy is relatively rare in pre-menopausal women; hence an elevated CA 125 warrants a broader differential diagnosis. It is important to have intra-abdominal TB as a differential even in the non-endemic settings to avoid delay in diagnosis and appropriate management.

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Clinical Usefulness of Cancer Antigen (CA) 125, Human Epididymis 4, and CA72-4 Levels and Risk of Ovarian Malignancy Algorithm Values for Diagnosing Ovarian Tumors in Korean Patients With and Without Endometriosis

Annals of Laboratory Medicine ◽

10.3343/alm.2020.40.1.40 ◽

2020 ◽

Vol 40 (1) ◽

pp. 40-47 ◽

Cited By ~ 3

Author(s):

Kyung-Hwa Shin ◽

Hyung-Hoi Kim ◽

Byung Su Kwon ◽

Dong Soo Suh ◽

Jong Kil Joo ◽

...

Keyword(s):

Ovarian Tumors ◽

Clinical Usefulness ◽

Ca 125 ◽

Ovarian Malignancy ◽

Cancer Antigen ◽

Korean Patients ◽

Human Epididymis

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CA 125 and TB

BMJ Case Reports ◽

10.1136/bcr-2020-238199 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238199

Author(s):

Mirae Park ◽

Ranju Dhawan ◽

Elizabeth Whittaker ◽

Onn Min Kon

Keyword(s):

Extrapulmonary Tuberculosis ◽

Abdominal Tuberculosis ◽

Needle Aspiration ◽

Tumour Marker ◽

Endobronchial Ultrasound ◽

Ca 125 ◽

Cancer Antigen 125 ◽

Cancer Antigen ◽

Transbronchial Needle Aspiration ◽

Specific Symptoms

We present two unusual presentations of extrapulmonary tuberculosis (EPTB) and more specifically intra-abdominal tuberculosis (TB). These cases were initially suspicious for ovarian cancer, presenting with non-specific symptoms, ultrasound-confirmed ascites and elevated cancer antigen 125 tumour marker (CA 125). However, in both cases chest imaging demonstrated enlarged mediastinal nodes amenable to endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), which confirmed the diagnosis of TB. Both cases were successfully treated with quadruple TB therapy.

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Risk of malignancy index in ovarian tumour for predicting ovarian malignancy by using Jacob’s score

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171385 ◽

2017 ◽

Vol 6 (4) ◽

pp. 1318

Author(s):

Rao P. S. ◽

Bala Reenu ◽

S. Prajwal

Keyword(s):

Predictive Value ◽

Case Fatality ◽

Ovarian Tumors ◽

Ca 125 ◽

Ovarian Malignancy ◽

Gynecological Malignancy ◽

Menopausal Women ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Post Menopausal

Background: Ovarian malignancy is the most common gynecological malignancy after the cancer of the cervix. A woman's risk at birth of ovarian cancer at some time in her life is 1 % to 1.5% and that of dying from cancer is almost 0.5 %. The most commonly occurring ovarian tumors are of epithelial in origin. It has the highest case-fatality ratio of all gynecological malignancies. Hence the early diagnosis is the most important factor for better prognosis. A clinical evaluation of the patient, followed by ultrasonography and CA-125 is helpful. This study aims to determine the role of Risk of Malignancy Index (Jacob’s RMI) in ovarian tumors for prediction of ovarian malignancy.Methods: This is a prospective cohort study. The present study was carried out at department of OBG, in collaboration with the Departments of Radio diagnosis and Pathology, AHRR, New Delhi. 100 patients meeting the inclusion and exclusion criteria were considered. Detailed clinical history, examination and ultrasonography (Abdomen and pelvis) were done. Estimation of CA125 was done thereafter. Calculated JACOBS RMI score was compared with operative surgical staging and histopathological-cytological examination of the specimen. Data obtained thereafter was analysed using appropriate and relevant statistical software.Results: In present study sensitivity of RMI Score in the pre-menopausal women was 66.7% and in post-menopausal women was 83.3%. Specificity of RMI Score in the pre-menopausal women was 96.3% and in post-menopausal women was 81.8%. The positive predictive value in the pre-menopausal women was 40% and in post-menopausal women was 71.4%. The negative predictive value in the pre-menopausal women was 98.7% and in post-menopausal women was 90%. Diagnostic accuracy in a case of premenopausal women was is 95.2% and 82.4% for postmenopausal women.Conclusions: The present study shows that RMI Score helps in identifying effectively those patients who require Staging Laparotomy and hence referral to Gynecologist Oncologist. Patients with ovarian masses with low risk of malignancy index can be treated by minimal access procedures.

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High CA 125 in a Case of Abdominal Tuberculosis mimicking Ovarian Malignancy

MGM Journal of Medical Sciences ◽

10.5005/jp-journals-10036-1088 ◽

2016 ◽

Vol 3 (1) ◽

pp. 51-52

Author(s):

Iqbal Tintoiya ◽

Nimisha Srivastava ◽

Pratima Thamke

Keyword(s):

Abdominal Tuberculosis ◽

Ca 125 ◽

Ovarian Malignancy

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Evaluation in the predictive value of serum human epididymal protein 4 (HE4), cancer antigen 125 (CA 125) and a combination of both in detecting ovarian malignancy

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2018-0029 ◽

2018 ◽

Vol 35 (1) ◽

Author(s):

Beng Hock Teh ◽

Soon Leong Yong ◽

Wee Wee Sim ◽

Kim Bee Lau ◽

Haris Njoo Suharjono

Keyword(s):

Predictive Value ◽

Area Under The Curve ◽

Pelvic Mass ◽

Premenopausal Women ◽

Ca 125 ◽

Diagnostic Study ◽

Ovarian Malignancy ◽

Cancer Antigen 125 ◽

Cancer Antigen ◽

Sensitivity Specificity

Abstract Background This study was conducted to evaluate the performance of human epididymal protein 4 (HE4), cancer antigen 125 (CA 125) and a combination of both via the Risk of Ovarian Malignancy Algorithm (ROMA) in detecting ovarian malignancy. Methods This was a diagnostic study enrolling 129 patients with pelvic mass(es) suspected of originating in the ovary who had been scheduled for surgery or radiological-guided biopsy. Serum HE4 and CA 125 levels were measured. HE4, CA 125 and ROMA were evaluated for sensitivity, specificity, positive predictive value and negative predictive value. The receiver operating characteristic (ROC) plots were graphed and area under the curve (AUC) values were calculated to investigate the accuracy of each marker for predicting ovarian malignancy. Results Overall, CA 125 remained significantly more sensitive (88.9% vs. 51.9%, p = 0.006) but less specific (56.9% vs. 95.1%, p < 0.001) than HE4. HE4 was superior to CA 125 in specificity (97.7% vs. 54.5%, p < 0.001) for premenopausal women. ROMA was non-significantly more sensitive (100.0% vs. 92.3%, p = 1.000) than CA 125 but both were equally specific (71.4%) for the postmenopausal group. In the premenopausal group, the AUC of serum HE4 was higher than serum CA 125 (0.851 vs. 0.817) but was equivalent to ROMA (0.851 vs. 0.859). In the postmenopausal group, ROMA exhibited an excellent AUC value as compared to CA 125 and HE4 (AUC of 0.907 vs. 0.874 vs. 0.863, respectively). Conclusion HE4 is useful in ruling out ovarian malignancy among premenopausal women. For postmenopausal women, ROMA appears to be an all-rounder with overall good sensitivity and specificity.

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Very High CA125 due to Non-neoplastic Lesion of Ovary

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v7i2.11146 ◽

2014 ◽

Vol 7 (2) ◽

pp. 52-54

Author(s):

KDB Bista

Keyword(s):

Tumor Marker ◽

Pelvic Inflammatory Disease ◽

Young Woman ◽

Inflammatory Disease ◽

Abdominal Tuberculosis ◽

Ca 125 ◽

Ovarian Malignancy ◽

Obstetrics And Gynaecology ◽

Neoplastic Lesion ◽

Very High

High CA-125 levels have been strongly associated with ovarian malignancy. But due to nonspecific nature of this tumor marker it has been found to be raised to high levels above 1000u/Ml even in some non neoplastic conditions which have to be kept in mind. A young woman was found to have very high Ca125 levels of 3500u/Ml after rupture of endometrioma. Endometrioma, pelvic inflammatory disease, abdominal tuberculosis are some of the nonneoplastic conditions associated with very high levels of Ca125. DOI: http://www.dx.doi.org/10.3126/njog.v7i2.11146 Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 2 / Issue 14 / July-Dec, 2012 / 52-54

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A diagnostic approach for differentiating abdominal tuberculosis from ovarian malignancy: a case series and literature review

BMC Proceedings ◽

10.1186/s12919-019-0180-y ◽

2019 ◽

Vol 13 (S11) ◽

Cited By ~ 1

Author(s):

Moh Nailul Fahmi ◽

Annisaa Pelita Harti

Keyword(s):

Ovarian Cancer ◽

Extrapulmonary Tuberculosis ◽

Clinical Manifestations ◽

Case Series ◽

Abdominal Tuberculosis ◽

Diagnostic Approach ◽

Ca 125 ◽

Imaging Features ◽

Ovarian Malignancy ◽

Cancer Antigen 125

Abstract Background Abdominal tuberculosis is an uncommon variant of extrapulmonary tuberculosis. It accounts for 3.5% of extrapulmonary tuberculosis. Diagnosis of abdominal tuberculosis is still a challenge due to its non-specific symptoms. Abdominal tuberculosis and ovarian cancer may show similar symptoms, laboratory and imaging features. The goal of our report is to emphasize for the need of a diagnostic approach based on clinical manifestations, laboratory, imaging findings, and additional tests for considering a diagnosis of abdominal tuberculosis rather than ovarian cancer. Case presentation We report 3 cases of abdominal tuberculosis in our Onco-gynaecology Division, Department of Obstetrics and Gynaecology, Sardjito Hospital, Yogyakarta, Indonesia in 2018 which were previously diagnosed as ovarian malignancy and managed surgically. All of our patients experienced abdominal pain and enlargement but only two of them had significant weight loss. The general symptoms were typically found in onco-gynaecology patients, especially in those with ovarian malignancy. Ultrasound examination showed multilocular masses, 2 of them with solid parts and ascites. Cancer antigen 125 (CA-125) levels were found increasing in those three patients. All of them were treated surgically and diagnosis of abdominal tuberculosis was established through the histopathological result of tissue biopsy. Based on our cases and literature, we consider the need of a diagnostic approach to differentiate abdominal tuberculosis from ovarian malignancy, an attempt to avoid unnecessary invasive procedures that put burden risk for the patients. Conclusion Minimally invasive tests to establish the diagnosis of abdominal tuberculosis should be optimized to reduce the burden risk of laparotomy. Careful diagnostic steps should be followed to avoid wrong diagnosis.

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The diagnostics significance of serum cancer antigen-125 in abdominal tuberculosis

International Surgery Journal ◽

10.18203/2349-2902.isj20180053 ◽

2018 ◽

Vol 5 (2) ◽

pp. 474 ◽

Cited By ~ 1

Author(s):

Anil Kumar ◽

Shiv S. Paswan ◽

Bindey Kumar ◽

Pragati Raj ◽

. Sunita

Keyword(s):

Disease Activity ◽

Abdominal Tuberculosis ◽

Serum Levels ◽

Serum Markers ◽

Ca 125 ◽

Control Group ◽

Cancer Antigen 125 ◽

Cancer Antigen ◽

Serial Measurement

Background: Various serum markers have been shown to be helpful in diagnosing tubercular infection, but none has been proven to be specific. The present study was undertaken to ascertain the role of serum cancer antigen (CA) -125 in diagnosing and monitoring therapeutic response in abdominal tuberculosis.Methods: Fifty diagnosed cases of abdominal tuberculosis and equal number of controls were included in the study. All the patients underwent clinical, radiological and hematological examination. Twenty-two patients had acute presentation and underwent laparotomy and twenty-eight patients had a chronic presentation and were managed conservatively. Biopsy was taken in all patients undergoing laparotomy. Serial measurement of serum levels of CA-125 were done at 0, 3 and 6 months in all the patients.Results: The CA-125 levels were significantly higher in tuberculosis patients than in control group (PPV 95.74% at 0 month). It was also observed that the levels correlated significantly with the disease activity (sensitivity 90 percent, specificity 96 percent) and return to normal level with the treatment given. It was shown that sensitivity reduced to 12 percent and 6 percent at 3 months and 6 months respectively after completion of treatment. The specificity however remained unchanged.Conclusions: The measurement of CA-125 may be a valuable parameter in diagnosing and determination of disease activity in abdominal tuberculosis.

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