PERITONEAL TUBERCULOSIS AS DIFFERENTIAL DIAGNOSIS OF PERITONEAL CARCINO-MATOSIS

Case Report: Female, 32 years old, previously healthy. Seeked medical attention complaining of right upper quadrant abdominal pain for 1 month associated with anorexia and dry cough. Were requested abdominal ultrasound (US) and computed tomography (CT). Were visualized ovarian cysts, moderate ascites and right pleural effusion. Referred to the cancer surgery service. In the diagnostic investigation a new CT showed massive ascites, diffuse thickening of the peritoneal leaflets, nodular lesions in the Glisson capsule, bilateral ovarian cysts and Omental Cake. A transvaginal USG was performed, which visualized a complex solid-cystic image in the right ovary. Requested tumor markers: CA-125 1986 U / ml, CA 19.9 and CEA results within normal range. After diagnostic investigation, proposed cytoreductive surgery. Intraoperatively, peritoneum and abdominal organs were covered with multiple granular lesions and Sclerosing encapsulating peritonitis. Freezing biopsy demonstrating chronic granulomatous process with the presence of giant, multinucleated Langhans cell macrophages. Performed omentectomy due to areas of necrosis. Were realized peritoneal biopsy and ascites fluid culture. Specific staining was performed on omentum samples and peritoneum biopsies for fungi and Mycobacterium, both negatives. Peritoneum sample culture without growth. The anatomopathological result concluded that it was tuberculoid granulomatous peritonitis. Further diagnostic investigation for tuberculosis (TB) showed only adenosine deaminase (ADA) in positive ascitic fluid, all other tests were negative (05 sputum samples with AFB and ascites fluid culture). RIPE started on the 5th postoperative day. Patient had complete remission of ascites and symptomatology. Discussion: The present case retracts the difficulty of making a differential diagnosis between carcinomatosis and peritoneal tuberculosis. Imaging and tumor markers (CA-125) corroborated the diagnosis of peritoneal carcinomatosis of probable ovarian origin. Sclerosing encapsulating peritonitis is rarely seen in peritoneal TB, there are less than 100 cases reported in the literature, which makes its diagnosis difficult. Conclusion: Peritoneal tuberculosis should be part of the differential diagnosis of peritoneal diseases, especially peritoneal carcinomatosis.

 

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Artikel online veröffentlicht:
23. Oktober 2019