Pelvic tuberculosis, echinococcosis, and actinomycosis: Great imitators of ovarian cancer

Aims To evaluate the demographic, laboratory, clinical and imaging findings, surgical procedures and complications in women with final pathology results of pelvic tuberculosis (PT), pelvic echinococcosis (PE) or pelvic actinomycosis (PA) following exploratory surgery for suspicion of ovarian cancer. Methods Among 492 operations from January 2005 through January 2013, we retrospectively reviewed women with PT (n=15), PE (n=6), or PA (n=5) mimicking ovarian cancer seen in an education and research hospital clinic. Results The mean ages of the women with PT, PE and PA were 34.2 +/- 9.4, 39.1 +/- 11 and 46.3 +/- 3.6years, respectively. The serum CA-125 was elevated in 14 (93%), four (67%) and four (80%) women, respectively. The average CA-125 levels were 242.8 +/- 240, 104.3 +/- 76.4 and 52.3 +/- 18.6IU/mL, respectively. The most common symptom was lower abdominal pain in 12 (87%), four (67%) and four (80%) women, respectively. The most common ultrasonography and computed tomography/magnetic resonance imaging finding was a pelvic mass in 11 (73%), six (100%) and five (100%) women, respectively. The most common surgical procedure was extensive adhesiolysis in 10 (67%), three (50%) and five (100%) women, respectively. Conclusions Pelvic tuberculosis, echinococcosis and actinomycosis must be included in the differential diagnosis of women suspected to have ovarian cancer with or without ascites and elevated CA-125 levels, especially in those living in endemic countries. During surgical exploration, frozen section analysis is important to avoid unnecessarily prolonged surgical procedures and retroperitoneal lymphadenectomy, which increases morbidity in women with these curable pelvic infectious conditions.