Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2012 May;162(1):105-8. doi: 10.1016/j.ejogrb.2012.02.010. Epub 2012 Mar 6.
To evaluate the characteristics of 20 patients diagnosed as tuberculous peritonitis (TBP) mimicking ovarian cancer during a 10-year period at a single center.
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.
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.
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.
评估在一家单中心 10 年间 20 例被误诊为结核性腹膜炎（TBP）的患者的特点。
在对 612 例卵巢恶性肿瘤手术中，我们回顾性地分析了 20 例于 2000 年至 2011 年间在一所大学附属医院术前被怀疑为卵巢恶性肿瘤但术后病理证实为 TBP 的患者的手术和病理报告。评估了患者的人口统计学特征、体格检查、盆腔检查、实验室检查和影像学检查。
11 例患者接受了剖腹探查术、腹腔镜检查和超声引导下 tru-cut 活检，分别为 2 例和 7 例。患者的平均年龄为 37.5±17.3 岁（范围 16-70 岁）。最常见的症状是腹痛（n=14%，70%）和腹胀（n=13%，65%）。16 例（80%）患者血清 CA125 升高，平均 CA125 水平为 289±186.2IU/ml。在超声和 CT 扫描中，19 例（85%）患者有腹水，12 例（60%）患者有盆腔肿块。7 例（35%）患者疑似 TBP，超声引导下 tru-cut 活检为首选一线方法。11 例（55%）患者接受了手术，在探查过程中发现广泛的粟粒状结节（n=9%，81%）、广泛粘连（n=5%，45%）、附件肿块（n=8%，72%）和干酪样坏死物质（n=4%，36%）。7 例（63%）患者行单侧（n=3%，27%）或双侧（n=4%，36%）输卵管卵巢切除术。
由于卵巢癌是一种严重的疾病，术前诊断 TBP 较为困难，因此通常需要剖腹探查来区分这两种疾病。超声引导下 tru-cut 活检在选择的患者中有用，而冷冻切片分析可避免在手术中进行危险的根治性手术。
