Table 2 A diagnostic approach to differentiated abdominal tuberculosis from ovarian malignancy
Abdominal Tuberculosis | Ovarian Malignancy | |
|---|---|---|
Chief complains | Symptoms may present in both diseases | |
abdominal pain, weight loss, abdominal mass, bloating, constipation, difficulty eating, signs of ascites [2, 3]. | ||
Specific symptoms | ||
fever (84.6%) | – | |
Physical examination | Common physical examination results of both diseases | |
• abdominal mass • ascites • abdominal tenderness • weight loss (underweight) [30] | ||
No single specific physical examination to differentiate abdominal TB and Ovarian Malignancy), following signs tend to be presented in one disease, but can be found in the other under specific condition | ||
• Solid organ enlargement (hepatomegaly, splenomegaly, or hepatosplenomegaly) • Inguinal lymphadenopathy | • Localised adnexal mass (in early stage) • Pleural effusion (advanced stage) • Liver metastasis (advanced stage) [31] | |
Abdominal Ultrasound | Common | |
Cystic mass | ||
Specific | ||
• Ascites (free or loculated, clear or complex with membranes, septum, or debris) • Peritoneal or omental thickening • Lymph node involvement (periportal, peripancreatic, mesenteric, or retroperitoneal • Bowel wall thickening or distended fluid-filled bowel loops. • Abdominal abscesses • Visceral involvement: homogeneous organomegaly, focal lesion, or calcified foci [32] | • Presence of ascites • Peritoneal masses (nodular), enlarged nodes, or matted bowel [33] • Solid part that is often nodular or papillary • Irregular, thick septations • Color or power Doppler demonstration of flow in the solid component [33]. | |
Abdominal CT scan | Common | |
Cystic mass | ||
Specific | ||
• Free or loculated ascites • Smooth thickening of the peritoneum • Lymph nodes enlargement with central necrosis and calcification • Thickening of the mesentery and omentum • Homogenous organomegaly [34] | • Primary ovarian mass • Multinodular and irregular peritoneal thickening • Homogeneous retroperitoneal lymph nodes enlargement • Omental cake | |
Common additional tests | ||
CA-125 | ||
HE4 | Increased (≤151.4 pmol/l) [14] | |
Specific Additional tests | ||
Specific Additional tests | • Polymerase chain reaction for mycobacterium of ascites fluid [18, 36] • Xpert MTB/RIF assay of sputum or tissue biopsy [20, 29] • Amino deaminase test of ascites fluid [23, 24] • T-cell-based interferon gamma release assay (IGRA) of ascites fluid or blood [25] • Visual diagnostic using laparoscopy approach. (thickened peritoneum with yellowish-white lesions, with or without adhesions, fibroadhesive pattern) [23] • Culture or histopathology examination of peritoneal biopsy (as gold standard either by laparoscopy or laparotomy) [23, 24, 27] | • Imaging for metastatic diseases (Magnetic resonance imaging, thorax X-ray, positron emission tomography) [37] • Paracentesis, thoracentesis, image-guided biopsy [38, 39] • Surgical evaluation |