Abdominopelvic tuberculosis mimicking advanced ovarian malignancy: a case series emphasising diagnostic pitfalls in a tuberculosis-endemic setting

Abdominopelvic tuberculosis is an important differential diagnosis in women presenting with features suggestive of advanced ovarian malignancy, particularly in tuberculosis-endemic regions. Overlapping clinical, radiological, and biochemical findings may lead to diagnostic misclassification and unnecessary more extensive surgical intervention. A retrospective case series of three female patients aged 18, 44, and 56 years respectively who presented with abdominal distension, pain, anorexia, and early satiety. Imaging studies in all the cases demonstrated ascites with adnexal masses and peritoneal thickening suggestive of advanced ovarian malignancy. Serum cancer antigen-125 levels were elevated in all the patients. Intraoperative findings revealed massive ascites, widespread peritoneal deposits, and omental caking, further reinforcing the suspicion of disseminated ovarian cancer. However, there was fibrinous adhesion which could be seen in both advanced ovarian cancer and abdominal tuberculosis. Also the histopathological examination of surgical specimens demonstrated chronic necrotising granulomatous inflammation consistent with tuberculosis in all three cases. All patients were subsequently commenced on anti-tuberculosis therapy with clinical improvement on follow-up. Abdominopelvic tuberculosis can closely mimic advanced ovarian carcinoma. In endemic settings, a high index of suspicion and early minimally invasive tissue diagnosis such as diagnostic laparoscopy or ultrasound-guided biopsy, are essential to avoid unnecessary more extensive surgery.