From the Guidelines
Yes, tuberculosis (TB) can present with a clinical picture similar to ovarian cancer, including elevated CA-125 levels and ascites. This phenomenon is known as peritoneal tuberculosis and can mimic ovarian malignancy closely, leading to unnecessary surgeries before the correct diagnosis is made. The key features of this presentation include:
- Elevated CA-125 levels, which can exceed 1000 U/mL, well above the typical cutoff of 35 U/mL used for ovarian cancer screening 1
- Ascites that is typically exudative with lymphocyte predominance, though this finding alone cannot reliably distinguish it from malignancy
- Other shared features such as pelvic masses, weight loss, and constitutional symptoms like fever and night sweats Diagnosis typically requires microbiological confirmation through culture or PCR testing of peritoneal fluid or tissue samples 1. Laparoscopy with biopsy showing caseating granulomas is often necessary for definitive diagnosis. Treatment involves standard anti-TB therapy with a combination of isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid and rifampin for an additional 4 months. This similarity occurs because both conditions trigger inflammatory responses in the peritoneum, causing CA-125 elevation, which is produced by mesothelial cells in response to various stimuli, not just ovarian cancer 1. It's crucial to consider TB in the differential diagnosis of patients presenting with ascites and elevated CA-125 levels to avoid misdiagnosis and unnecessary surgical interventions. The elevation of CA-125 in TB patients is not specific to ovarian cancer, as it can be elevated in various conditions, including cirrhosis and pancreatic cancer 1. Therefore, a comprehensive diagnostic approach is necessary to accurately diagnose and manage patients presenting with these symptoms.
From the Research
Clinical Presentation of TB and Ovarian Cancer
- Tuberculosis (TB) can present with a similar clinical picture to ovarian cancer, including elevated Cancer Antigen 125 (CA 125) levels and ascites 2, 3, 4, 5, 6.
- The symptoms and imaging examinations of peritoneal tuberculosis may resemble those of ovarian carcinoma, making it an important differential diagnosis to consider 4, 6.
Elevated CA 125 Levels in TB
- Elevated CA 125 levels are not specific to ovarian cancer and can be encountered in many benign and malignant conditions, including tuberculosis 4.
- CA 125 levels can be used to monitor disease activity in non-neoplastic ascitic states, particularly to monitor response to treatment of pelvic-peritoneal tuberculosis 3.
- Normalization of CA 125 levels has been observed in patients with peritoneal tuberculosis after antituberculosis therapy 3, 4, 6.
Diagnostic Challenges
- The diagnosis of peritoneal tuberculosis can be challenging, and a high index of suspicion is required, especially in women from countries with a high prevalence of tuberculosis 6.
- Diagnostic laparoscopy or laparotomy may be necessary to confirm the diagnosis of peritoneal tuberculosis and avoid unnecessary radical surgery 4, 5, 6.
- Adenosine deaminase (ADA) testing of ascitic fluid and PCR can be helpful in diagnosing peritoneal tuberculosis 4.