RURAL HOSPITAL CORRELATION OF CLINICAL PRESENTATION, HISTOPATHOLOGY, AND POLYMERASE CHAIN REACTION FOR GENITAL TUBERCULOSIS DIAGNOSIS

In India, vaginal tuberculosis (FGTB) is a common cause of infertility, but diagnosis is difficult because of the form of the disease of people in need. Traditional diagnostic methods include the detection of rapid bacilli acid in endometrial or peritoneal biopsy, epithelioid granuloma biopsy, or a positive Expert type in biopsy, although this is only available in a small percentage of cases, leaving patients many are not available. Diagnosis of GTB by PCR along with histopathological findings leads to high sensitivity and specificity. So, both diagnostic and operative laparoscopy and hysteroscopy are the modalities essential for management of genital TB in infertile women. This review discusses various diagnostic modalities including endometrial or peritoneal biopsy to detect epithelioid granuloma on microscopy, role of PCR for GTB and correlation of two for early diagnosis of genital tuberculosis so that management will be started at early stage which can prevent patient from getting permanent damage to organs. Tuberculosis being endemic in counties likes India; it is often a leading cause of infertility. Early diagnosis is crucial because, by the time patient reports with infertility, already the damage has started and reverting tubal patency is almost impossible. Early diagnosis typically fails in developing countries, primarily because there are no pathognomonic signs of the disease and either poor sensitivity or procedurally invasive diagnostic methods are in use.

Peritoneal Chlamydia trachomatis Infection as a Cause of Ascites: A Diagnosis Not to Be Missed

Ascites is a common complication of several conditions, but it is rare in cases of <i>Chlamydia trachomatis</i> infection. We report a 36-year-old patient presenting with abdominal swelling for a week prior to hospitalization. An extensive workup excluded liver or heart disease and malignancy. A computed tomography scan demonstrated massive ascites and severe thickening of peritoneal reflections. Laboratory tests showed low serum-ascites albumin gradient, high total protein, and low adenosine. Diagnostic laparoscopy revealed inflammatory signs of both fallopian tubes. The histopathological results from peritoneal biopsy were consistent with lymphoid proliferation with reactive lymphoplasmacytic infiltrate. A gynecological investigation showed a positive DNA for <i>C. trachomatis</i> in the cervical swab. After treatment with doxycycline, there was a complete resolution of ascites.

Peritonitis and splenitis caused by MAC-infection in an immunosuppressed patient

Primary (hematogenic) peritonitis caused by non-tuberculosis mycobacteria is extremely rare in the clinical practice. The main number of reported episodes of primary intraabdominal infection is associated with M. tuberculosis and the development of granulomatous inflammation of the peritoneum visually similar to carcinomatosis. The vast majority of reports of peritonitis associated with non-tuberculosis mycobacteria are interlinked with chronic peritoneal dialysis or foreign bodies of the abdominal cavity, when an infection is carried out by the contact through a dialysis catheter, prosthesis or a gastric banding device. The article describes a clinical case of peritonitis and splenitis caused by M. avium with hematogenic spread of infection from the primary pulmonary focus in a young patient with immunosuppression. Diagnosis of such peritonitis at the preoperative stage is extremely difficult due to the similarity of symptoms with atypical appendicitis or infected ascites. The intraoperative picture also did not allow us to assume a mycobacterial etiology of the process, and the absence of a focal point of peritonitis made it necessary to thoroughly understand the situation. Only a peritoneal biopsy and a complete laboratory examination of exudate allowed us to verify the diagnosis, to understand the pathogenetic mechanisms of the disease and to start a timely etiotropic therapy.

Evaluation of Imaging-Guided Peritoneal Biopsy in Diagnosis of Ascites of Undetermined Origin

Background Regarding ascites of unknown origin, diagnostic laparoscopy is an invasive procedure, there are certain complications reported with this procedure i.e. haemorrhage, infection and air embolism. Ultrasound-guided percutaneous biopsies are easy to perform in an outpatient clinic. This procedure is safe, has a low incidence of injury and does not cause serious complications. Computed tomography (CT)-guided percutaneous biopsy is not a real-time operation, and it involves quite a few complicated procedures. Aim To evaluate the role of imaging guided peritoneal biopsy in diagnosis of ascites of undetermined origin (ascites of local cause). 2ry aim was to present the role of imaging-guided biopsy of the omentum or other extravisceral masses as a minimally invasive procedure compared to laparoscopy in the diagnosis of these difficult-to-diagnose group of patients. Patients and methods Patients with clinically suspected and radiologically confirmed ascites of unknown etiology represented the population of our study. These patients were referred to the ascites study group (ASG) and admitted to Tropical Medicine Department, Ain Shams University Hospitals in the period from June 2017 to November 2019. The study was conducted on 63 patients with ascites of unknown etiology fulfilling the inclusion criteria. They underwent ultrasound-guided cytology/biopsy of peritoneum, omentum or extravisceral masses. CT guided percutaneous peritoneal biopsy was done in cases of failure of ultrasound guided technique. Laparoscopy was needed when the imaging-guided biopsy was not diagnostic. Results 54 patients (85.7%) underwent US guided biopsies, 48 patients of them (76.2%) were successfully diagnosed, while the other six patients (9.5%) were sent for laparoscopy after nonconclusive histopathological examination of the biopsies taken US guided. The patients underwent laparoscopy were successfully diagnosed except for one patient who died intraoperatively. The other nine patients (14.3%) underwent CT guided biopsies (not accessible by US guided modality) and all of them were successfully diagnosed. Imaging guided biopsies had perfect sensitivity (100%) and NPV (100%) in differentiating neoplastic lesions. We found that imaging-guided procedures had a high diagnostic accuracy of 88.8% & 100% done US & CT guided respectively with a sensitivity of 100%, specificity of 83.3% and NPV of 100%, which could distinguish malignant from benign ascites. Complications were most frequent in laparocopy, followed by CT guided biopsies and least in US guided biopsies with P-value &lt;0.001. Conclusion Percutaneous imaging-guided biopsy (US/CT guided) of the peritoneum, omenta, and mesentery has been established as a safe, well-tolerated procedure with high diagnostic accuracy. It can minimize further unnecessary invasive procedures e.g laparoscopy. It can help in directing the management, shortening the patient’s hospital stay and reducing the costs and complications.

Status of Surgical Management of Borderline Ovarian Tumors in France: are Recommendations Being Followed? Multicentric French Study by the FRANCOGYN Group

Background Borderline ovarian tumors (BOTs) are tumors with a favorable prognosis but whose management by consensus is essential to limit the risk of invasive recurrence. This study aimed to conduct an inventory of surgical practices for BOT in France and to evaluate the conformity of the treatment according to the current French guidelines. Methods This retrospective, multicenter cohort study included nine referral centers of France between January 2001 and December 2018. It analyzed all patients with serous and mucinous BOT who had undergone surgery. A peritoneal staging in accordance with the recommendations was defined by performance of a peritoneal cytology, an omentectomy, and at least one peritoneal biopsy. Results The study included 332 patients. A laparoscopy was performed in 79.5% of the cases. Treatment was conservative in 31.9% of the cases. The recurrence rate was significantly increased after conservative treatment (17.3% vs 3.1%; p < 0.001). Peritoneal cytology was performed for 95.5%, omentectomy for 83.1%, and at least one biopsy for 82.2% of the patients. The overall recurrence rate was 7.8%, and the recurrence was invasive in 1.2% of the cases. No link was found between the recurrence rate and the conformity of peritoneal staging. The overall rate of staging noncompliance was 22.9%. Conclusion The current standards for BOT management seem to be well applied.

Metastatic Malignant Peritoneal Mesothelioma Mimicking an Autoinflammatory Syndrome in a 12-Year-Old Boy

A case of a malignant peritoneal mesothelioma mimicking an autoinflammatory syndrome in a 12-year-old boy is reported. The patient initially presented with lymphadenopathy and weight loss but without abdominal pain. Three things confounded the initial diagnosis: a positive test result for a gene related to cryopyrin-associated periodic syndrome, a positive response to the autoinflammatory syndrome treatment, and a lymph node biopsy which showed “hyperplastic mesothelial cells in the lymph sinuses.” His symptoms relapsed several years later, and a peritoneal biopsy confirmed the final diagnosis. Complete morphological, immunohistochemical, and molecular diagnoses are described. A translocation in the TERT gene involving the truncation of the promoter was found in the mesothelioma. The translocation has never been described in mesotheliomas and is of an unknown significance.

Peritoneal biopsy frozen section: cachexia manifesting as signet ring-like cells

Peritoneal metastases from signet ring cell adenocarcinoma may be overlooked at laparoscopy, resulting in problematic false-negative diagnoses. Conversely, false-positive diagnoses are rarely reported. For the surgeon, cachexia may rise suspicion for peritoneal metastases by exhibiting a worrisome micronodular appearance of the peritoneum, and atrophic adipocytes looks like signet ring cells at the microscopical level. Being aware of this underdiagnosed condition may help avoiding unfortunate false-positive diagnoses of peritoneal metastases during intraoperative consultation.