scholarly journals Abdominal tuberculosis with a Pseudo-Sister Mary Joseph nodule mimicking peritoneal carcinomatosis

2019 ◽  
Vol 12 (6) ◽  
pp. e229624 ◽  
Author(s):  
Amine Awad ◽  
Tom Pampiglione ◽  
Zaker Ullah
Keyword(s):  
Transvaginal Ultrasound ◽  
Positive Culture ◽  
Ct Scanning ◽  
Abdominal Tuberculosis ◽  
Tumour Marker ◽  
Interferon Γ ◽  
Ca 125 ◽  
Fluid Analysis ◽  
Release Assay ◽  
Sister Mary Joseph

A 46-year-old woman presented in severe abdominal pain on a background of 3 months of weight loss and intermittent vomiting. She had visited East Africa 6 months prior but reported no unwell contacts. On examination, she had generalised abdominal tenderness, distension and a painful paraumbilical swelling. CT scanning confirmed small bowel obstruction and revealed widespread peritoneal nodules, lymphadenopathy, ascites and a soft tissue paraumbilical mass. CA-125 tumour marker was elevated. However, transvaginal ultrasound scanning showed normal-appearing ovaries. She underwent a diagnostic laparoscopy for ascitic fluid analysis and biopsy of omental and peritoneal nodules, which revealed a lymphocytic exudate and caseating granulomas, respectively. Interferon-γ release assay and repeated stains for acid-fast bacilli were negative. She was commenced on antituberculous chemotherapy for a presumed diagnosis of abdominal tuberculosis. Positive culture results 2 weeks later confirmed Mycobacterium tuberculosis infection. The patient experienced a complete resolution of symptoms within 6 weeks of treatment.

CA 125 and TB

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.

scholarly journals Benign Ovarian Cysts with Raised CA-125 Levels: Do We Need to Evaluate the Fallopian Tubes?

2020 ◽  
Vol 12 (04) ◽  
pp. 276-280
Author(s):  
Devesh Sharma ◽  
Anjali Vinocha
Keyword(s):  
Ovarian Cancer ◽  
Ovarian Cyst ◽  
Transvaginal Ultrasound ◽  
Premenopausal Women ◽  
Carbohydrate Antigen ◽  
Ca 125 ◽  
Ovarian Cysts ◽  
Fallopian Tubes ◽  
Case Record ◽  
Carbohydrate Antigen 125

Abstract Objectives It is not clearly known whether some benign (simple) ovarian cysts can convert into cancerous cysts. Size of cyst and wall abnormalities do predict the potentiality of malignancy. Not many studies have been done to explore the malignant potential of large-sized (> 5 cm) unilocular ovarian cysts without wall abnormalities. This study evaluated the correlation between ultrasonographic size of benign ovarian cysts and carbohydrate antigen 125 (CA-125) levels. Methodology Sixty (60) premenopausal women were recruited for the study preoperatively, based on transvaginal ultrasound (TVUS) findings present in the case record sheet received along with the CA-125 sample in the biochemistry laboratories. Those cases with elevated CA-125 levels were selected, where patients had unilocular ovarian cysts without wall abnormalities. CA-125 was done using ECLIA methodology (Cobas e411, Germany). Statistical correlation was calculated between the ovarian cyst size and CA-125 levels using Spearman’s Rho coefficient. Results Mean age group of subjects were 29.7 ± 7.3 years and mean value of CA-125 (normal < 35 IU/mL) was found to be increased: 118.0 ± 147.1 IU/mL so was the mean diameter of cysts (cut off ≤ 5 cm): 48.6 ± 59.8 cm. No correlation was found between CA-125 levels and volume of ovarian cyst (r = 0.005, p = 0.680) for all subjects. Conclusions The lack of correlation between size of ovarian cysts and CA-125 levels provides a hint that the ovarian cyst epithelium does not directly express CA-125 and it may come from sites like the fallopian tube. Thus, raised level of CA-125 in benign ovarian cyst should be followed-up more closely, demanding assessment of fallopian tubes for early diagnosis of ovarian cancer. Also, algorithms can be explored to include size of ovarian cyst and CA 125 levels to predict ovarian cancer.

Einführung des Interferon-γ-Release Assay bei Tuberkulose-Umgebungsuntersuchungen – ein 2-Jahres Projekt in Niedersachsen

2010 ◽  
Vol 73 (06) ◽  
pp. 363-368 ◽  
Author(s):  
D. Wagner ◽  
M. Scharlach ◽  
J. Sielski ◽  
J. Dreesman ◽  
M. Pulz
Keyword(s):  
Interferon Γ ◽  
Release Assay

scholarly journals Meigs' syndrome with elevated CA 125: case report

2003 ◽  
Vol 121 (5) ◽  
pp. 210-212 ◽  
Author(s):  
Sabas Carlos Vieira ◽  
Leonardo Halley Carvalho Pimentel ◽  
José Carlos Castelo Branco Ribeiro ◽  
Argemiro Ferreira de Andrade Neto ◽  
Jerúsia Oliveira Ibiapina de Santana
Keyword(s):  
Case Report ◽  
Pleural Effusion ◽  
Ovarian Tumor ◽  
Frozen Section ◽  
Transvaginal Ultrasound ◽  
Elevated Serum ◽  
Ca 125 ◽  
Brazilian Woman ◽  
Thoracic Drainage ◽  
Benign Ovarian Tumor

CONTEXT: Meigs' syndrome consists of a benign ovarian tumor accompanied by ascites and hydrothorax. Elevated serum CA 125 levels in postmenopausal women with solid adnexal masses, ascites and pleural effusion are highly suggestive for malignant ovarian tumor. However, patients with Meigs' syndrome can also have elevated serum CA 125 levels. The authors report a case of Meigs' syndrome with elevated CA 125 level. OBJECTIVE: This is a case report of Meigs' syndrome with elevated CA 125 level. CASE REPORT: A 65-year-old Brazilian woman had presented progressive dyspnea, weight loss and decline in general condition over the 7 months preceding admission to our service. In another hospital, the patient had been submitted to thoracic drainage due to pleural effusion. With recurrence of the pleural effusion and increase in abdominal volume due to ascites and a pelvic mass, the patient sought our service. Transvaginal ultrasound showed an extensive adnexal solid mass of 16.4 x 10.8 cm located in the pelvis without exact limits, and the serum CA 125 level was elevated. With a preoperative diagnosis of ovarian carcinoma, the patient was submitted to exploratory laparotomy, which revealed a left ovarian tumor. The frozen section diagnosis was thecoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histology of the specimen confirmed the diagnosis of thecoma. The patient was asymptomatic with a normal serum CA 125 level 20 months after the operation.

scholarly journals Feasibility of the Interferon-γ Release Assay for the Diagnosis of Genitourinary Tuberculosis in an Endemic Area

2013 ◽  
Vol 54 (2) ◽  
pp. 123 ◽  
Author(s):  
Jong Keun Kim ◽  
Woo Jin Bang ◽  
Cheol Young Oh ◽  
Changhee Yoo ◽  
Jin Seon Cho
Keyword(s):  
Endemic Area ◽  
Interferon Γ ◽  
Genitourinary Tuberculosis ◽  
Release Assay

scholarly journals Anastrozole and Levonorgrestrel-Releasing Intrauterine Device in the Treatment of Endometriosis: A Randomized Clinical Trial.

2020 ◽  
Author(s):  
Pedro Acién ◽  
Irene Velasco ◽  
Maribel Acién
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Transvaginal Ultrasound ◽  
Intrauterine Device ◽  
Conservative Surgery ◽  
University Hospital ◽  
Ca 125 ◽  
Fertility Sparing ◽  
Ultrasound Guided Puncture ◽  
Guided Puncture

Abstract Background: To study the effectiveness of an aromatase inhibitor (Anastrozole) associated to levonorgestrel-releasing intrauterine device (LNG-IUD, Mirena®) in the treatment of endometriosis.Methods: Prospective, randomized clinical trial. Setting: University Hospital (single center). Elegibility criteria: Endometriomas >3×4 cm, CA-125>35 U/mL and endometriosis symptoms. Patients: Thirty-one women randomized to anastrozole+Mirena®+Conservative Surgery(CS) (n=8), anastrozole+Mirena®+transvaginal ultrasound-guided puncture-aspiration (TUGPA) (n=7), Mirena®+CS (n=9), or Mirena®+TUGPA (n=7). Interventions: Anastrozole 1 mg/day and/or only Mirena® for 6 months; CS (ovarian and fertility-sparing) or TUGPA of endometriomas one month after starting medical treatment. Main Outcome Measures: Visual analogic scale for symptoms, CA-125 levels, ultrasound findings of endometriomas and recurrences. Results: A significant improvement in symptoms during the treatment (difference of 43%, 95% CI 29.9-56.2) occurred, which was maintained at 1 and 2 years. It was more significant in patients treated with anastrozole (51%, 95% CI 33.3-68.7). For CA-125, the most significant decrease was observed without anastrozole (73.8%, 95% CI 64.2-83.4 vs. 53.8%, 95% CI 25.7-81.6 under Mirena®+anastrozole). After CS for endometriosis, a reduction of findings of endometriomas and long-term recurrences occurred, with or without anastrozole. At 4,2±1,7 years (95% CI 3,57-4,85), 88% of the patients who underwent CS were asymptomatic, without medication or reoperation, compared to only 21% if TUGPA was performed, with or without anastrozole (p=0.019). Conclusions: Dosing anastrozole for 6 months, starting one month before CS of endometriosis, reduces more significantly the painful symptoms and delays recurrences, but has no other significant advantages over the single insertion of LNG-IUD (Mirena®) during the same time. Anastrozole and/or only Mirena® associated with TUGPA are not effective.

scholarly journals The role of laparoscopy in diagnosis of patients with chronic abdominal pain

2016 ◽  
Vol 4 (1) ◽  
pp. 326 ◽  
Author(s):  
Pradeep Saxena
Keyword(s):  
Abdominal Pain ◽  
Clinical Picture ◽  
Descriptive Analysis ◽  
Abdominal Tuberculosis ◽  
Chronic Abdominal Pain ◽  
Diagnostic Dilemma ◽  
Chronic Appendicitis ◽  
Fluid Analysis ◽  
Conclusive Diagnosis

Background: Chronic abdominal pain still remains one of the leading clinical problems presenting to physicians. Reaching a definitive diagnosis and prompt management is usually delayed because invasive investigations are frequently required to come to a conclusive diagnosis. The aim was to study the varied clinical picture of chronic abdominal pain and evaluate the role of laparoscopy in reaching a conclusive diagnosis in these patients.Methods: A prospective and retrospective study of 142 patients of chronic abdominal pain who underwent diagnostic laparoscopy in our surgery department from June, 2006 to December, 2015 was done. A descriptive analysis of data collected from case records of these patients was done to study the varied clinical picture, laboratory reports, radiological findings, laparoscopic findings and histological reports. The usefulness of laparoscopy to confirm the diagnosis and in clinical management of these patients of chronic abdominal pain was evaluated.Results:Laparoscopy was performed in 142 patients of chronic abdominal pain with unsettled diagnosis. A conclusive diagnosis could be made in 136 of these patients. The common causes of chronic abdominal pain were abdominal tuberculosis, adhesions, bands, small intestinal strictures, chronic appendicitis, abdominal malignancy and various gynecological diseases. Gynecological problems causing chronic abdominal pain were pelvic inflammatory disease, ovarian cyst, tubo-ovarian mass, hydrosalpinx, fibroid uterus, bulky uterus, endometriosis. Thus laparoscopy provided positive diagnosis of in 136 (95.77%) patients based on laparoscopic findings, histological reports, ascitic fluid analysis and cytology.Conclusions:In patients suspected to have abdominal pathology early laparoscopy may be useful to establish a conclusive diagnosis with acceptably low morbidity (<5 %). An early resort to laparoscopy can resolve the diagnostic dilemma and early treatment can be instituted.

scholarly journals Anastrozole and Levonorgrestrel-Releasing Intrauterine Device in the Treatment of Endometriosis: A Randomized Clinical Trial.

2020 ◽  
Author(s):  
Pedro Acién ◽  
Irene Velasco ◽  
Maribel Acién
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Transvaginal Ultrasound ◽  
Intrauterine Device ◽  
Conservative Surgery ◽  
University Hospital ◽  
Ca 125 ◽  
European Medicines Agency ◽  
Fertility Sparing ◽  
Ultrasound Guided Puncture

Abstract Background: To study the effectiveness of an aromatase inhibitor (Anastrozole) associated to levonorgestrel-releasing intrauterine device (LNG-IUD, Mirena®) in the treatment of endometriosis.Methods: Prospective, randomized clinical trial. Setting: University Hospital (single center). Elegibility criteria: Endometriomas >3×4 cm, CA-125>35 U/mL and endometriosis symptoms. Patients: Thirty-one women randomized to anastrozole+Mirena®+Conservative Surgery(CS) (n=8), anastrozole+Mirena®+transvaginal ultrasound-guided puncture-aspiration (TUGPA) (n=7), Mirena®+CS (n=9), or Mirena®+TUGPA (n=7). Interventions: Anastrozole 1 mg/day and/or only Mirena® for 6 months; CS (ovarian and fertility-sparing) or TUGPA of endometriomas one month after starting medical treatment. Main Outcome Measures: Visual analogic scale for symptoms, CA-125 levels, ultrasound findings of endometriomas and recurrences.Results: A significant improvement in symptoms during the treatment (difference of 43%, 95% CI 29.9-56.2) occurred, which was maintained at 1 and 2 years. It was more significant in patients treated with anastrozole (51%, 95% CI 33.3-68.7). For CA-125, the most significant decrease was observed without anastrozole (73.8%, 95% CI 64.2-83.4 vs. 53.8%, 95% CI 25.7-81.6 under Mirena®+anastrozole). After CS for endometriosis, a reduction of findings of endometriomas and long-term recurrences occurred, with or without anastrozole. At 4,2±1,7 years (95% CI 3,57-4,85), 88% of the patients who underwent CS were asymptomatic, without medication or reoperation, compared to only 21% if TUGPA was performed, with or without anastrozole (p=0.019).Conclusions: Dosing anastrozole for 6 months, starting one month before CS of endometriosis, reduces more significantly the painful symptoms and delays recurrences, but has no other significant advantages over the single insertion of LNG-IUD (Mirena®) during the same time. Anastrozole and/or only Mirena® associated with TUGPA are not effective.Details of trial registration: Eudra CT System of the European Medicines Agency (London, 29-Sept-2008) Nº EudraCT: 2008-005744-17 (07/11/2008). Date of enrolment of first patient: 15/01/2009.

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