Peritoneal tuberculosis: A retrospective review of 20 cases and comparison with primary peritoneal carcinoma

Introduction: To evaluate the clinical features of peritoneal tuberculosis (TB) and to compare them with those of primary peritoneal carcinoma (PPC). Methods: We conducted a retrospective review of women with peritoneal TB who were managed at Samsung Medical Center from January 1996 to October 2006. As a control sample, patients with a diagnosis of PPC during the same period were also selected for comparison. Results: During the study period, we identified 20 female patients with peritoneal TB. The median age was 39 years (range, 23Y69 years), and the median cancer antigen 125 (CA-125) level was 448 U/mL (range, 32Y1725 U/mL). Seventeen patients with PPC whom we examined were older, with a median age of 63 years (range, 50Y73 years); their median CA-125 level was higher at 1848 U/mL (range, 42Y14,380 U/mL). Compared with those of PPC, the radiologic findings of peritoneal TB indicated less severe involvement of the omentumand the mesentery (P = 0.03). Among the 20 patients who underwent operations, 6 (30%) underwent exploratory laparotomy; 12 (60%), diagnostic laparoscopy; and 2 (10%), laparoscopy converted to laparotomy because of severe adhesion. Frozen tissue sections revealed chronic granulomatous tissue reaction in 15 (83.3%) of 18 women with peritoneal TB. Conclusions: Maintaining a high index of suspicion is very important for the successful treatment of peritoneal TB, especially in developing countries. Age, CA-125 level, and omental involvement as identified by computed tomography may be helpful for the differential diagnosis of peritoneal TB and PPC.