title: Peritoneal tuberculosis mimicking ovarian cancer.
abstract: OBJECTIVE
  To evaluate the characteristics of 20 patients diagnosed as tuberculous peritonitis (TBP) mimicking ovarian cancer during a 10-year period at a single center.
  
  
  METHODS
  Among 612 operations for ovarian malignancy we retrospectively reviewed the surgical and pathological reports of 20 patients suspected preoperatively as having ovarian malignancy but whose pathological results revealed TBP, between 2000 and 2011 in a university clinic. Demographic characteristics, physical and pelvic examination, laboratory investigations and radiological imaging of the patients were evaluated retrospectively.
  
  
  RESULTS
  Diagnostic laparotomy, laparoscopy and ultrasound guided tru-cut biopsy were performed in 11, 2 and 7 of the 20 patients, respectively. The mean age of the patients was 37.5 ± 17.3 years (range 16-70 years). The most common symptoms were abdominal pain (n=14%, 70%) and abdominal distension (n=13%, 65%). Serum CA 125 was elevated in 16 (80%) cases and the average CA 125 level was 289 ± 186.2 IU/ml. During ultrasonographic imaging and CT scans, ascites and a pelvic mass were detected in 19 (85%) and 12 (60%) patients respectively. TBP was suspected in 7 (35%) patients and ultrasound guided tru-cut biopsy was preferred as a first-line approach. Surgery was performed in 11 patients (55%) and during exploration widespread miliary nodules (n=9%, 81%), widespread adhesion (n=5%, 45%), adnexal mass (n=8%, 72%) and caseous necrotic substance (n=4%, 36%) were observed. Patients underwent unilateral (n=3% 27%) or bilateral (n=4%, 36%) salpingo-oophorectomy in seven (63%) cases.
  
  
  CONCLUSIONS
  Since ovarian cancer is a serious condition and preoperative diagnosis of TBP is difficult, laparotomy is usually mandatory to distinguish these two entities. Ultrasound guided tru-cut biopsy is useful in selected patients and frozen section analysis avoids hazardous radical surgery at operation.
authors.affiliation: Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey. tufanoge@yahoo.com
authors.forename: Tufan
authors.initials: T
authors.lastname: Oge
authors.forename: S Sinan
authors.initials: SS
authors.lastname: Ozalp
authors.forename: Omer T
authors.initials: OT
authors.lastname: Yalcin
authors.forename: Sare
authors.initials: S
authors.lastname: Kabukcuoglu
authors.forename: Mahmut
authors.initials: M
authors.lastname: Kebapci
authors.forename: Deniz
authors.initials: D
authors.lastname: Arik
authors.forename: Tugba
authors.initials: T
authors.lastname: Isikci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001201:Ascites / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D010052:Ovariectomy; D014395:Peritonitis, Tuberculous / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies