Peritoneal Tuberculosis Presenting as Chronic Ascites With Scrofula: A Case Report

Abdominal tuberculosis is an increasingly common disease that poses diagnostic challenge, as the nonspecific features of the disease which may lead to diagnostic delays and development of complications. This condition is regarded as a great mimicker of other abdominal pathology. A high index of suspicion is an important factor in early diagnosis. Abdominal involvement may occur in the gastrointestinal tract, peritoneum, lymphnodes or solid viscera. Various investigative methods have been used to aid in the diagnosis of abdominal tuberculosis. Early diagnosis and initiation of antituberculous therapy and surgical treatment are essential to prevent morbidity and mortality. Most of the patients respond very well to standard antitubercular therapy and surgery is required in some cases. Imaging plays an important role in diagnosis of abdominal tuberculosis because early recognition of this condition is important. Abdominal tuberculosis constitutes a chief public health setback, presents a diagnostic challenge requiring a high index of clinical suspicion. Young age at presentation, delayed presentation, poverty & high morbidity & mortality are among the hallmarks of the disease in this region. These challenges need to be addressed in order to deliver optimal care for these patients. Early diagnosis, early antituberculous therapy & surgical treatment of the related complications are important for survival.

ObjectivesThe global obesity epidemic has great impact on the prevalence of low-grade endometrial carcinoma. The preoperative tumor serum marker cancer antigen 125 (CA-125) might contribute to improved identification of high-risk patients within this group. The study aimed to investigate the prognostic value of CA-125 in relation to established preoperative prognosticators, with a focus on identifying patients with poor outcome in low-grade endometrial carcinoma (EC) patients.MethodsProspective multicenter cohort study including all consecutive patients surgically treated for endometrial carcinoma in nine collaborating hospitals from September 2011 until December 2013. All preoperative histopathological diagnoses were reviewed in a blinded manner. Associations between CA-125 and clinicopathological features were determined. Univariable and multivariable analysis by Cox regression were used. Separate analyses were performed for preoperatively designated low-grade and high-grade endometrial carcinoma patients.ResultsA total of 333 patients were analyzed. CA-125 was associated with poor prognostic features including advanced International Federation of Gynecology and Obstetrics (FIGO) stage. In multivariable analysis, age, preoperative tumor and CA-125 were significantly associated with disease-free survival (DFS); preoperative grade, tumor type, FIGO and CA-125 were significantly associated with disease-specific survival (DSS). Low-grade EC patients with elevated CA-125 revealed a DFS of 80.6% and DSS of 87.1%, compared to 92.1% and 97.2% in low-grade EC patients with normal CA-125.ConclusionPreoperative elevated CA-125 was associated with poor prognostic features and independently associated with DFS and DSS. Particularly patients with low-grade EC and elevated CA-125 represent a group with poor outcome and should be considered as high-risk endometrial carcinoma.

The objective of this study was to determine how often an elevated cancer antigen (CA) 19-9 (≥ 37 U/mL) was present during the preoperative evaluation of women with a mature cystic teratoma (MCT). This was a retrospective, consecutive case series (N = 139) of histologically proven MCT treated at Montefiore Medical Center from 1997 to 2008. Data were analyzed for patient and tumor characteristics, tumor markers (CA 19-9, CA 125, and carcinoembryonic antigen [CEA]), preoperative imaging, and procedure. CA 19-9 was elevated in 37.4% of patients. Elevated CA 19-9 was not significantly associated with age, race, CA 125 (≥35 U/mL), CEA (≥5 ng/mL), MCT size, or the presence of bilateral MCTs. Of the patients, 59% were ≥40 years old. Age <40 years was associated with cystectomy rather than oophorectomy (P < .001), regardless of CA 19-9 (P = .09). Elevated preoperative CA 19-9 in patients with MCT was associated with increased preoperative computed tomography (P = .04).

Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated cancer antigen 125 (CA-125) in Meigs' syndrome is an unusual clinical condition reported in few cases. We report here on a 61-year-old woman who presented with dyspnea; in imaging assessment, a heterogeneous pelvic mass measuring 12 × 11 cm with ascitic fluid was reported. Pleural effusion was detected on Chest X-ray. Aspiration of pleural fluid showed no evidence of malignancy. CA-125 level was 347 IU/mL. The patient underwent laparotomy during which a mass measuring 12 × 11 cm was detected in her left adnexa. Histology showed ovarian thecoma. The mass was resected, and, after that, the symptoms disappeared and CA-125 level reached 19 IU/mL. The patient had experienced no problem after 12 months of follow up. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA-125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.

Gallbladder neuroendocrine carcinoma (GB-NEC) is a group of rare and heterogeneous neoplasms and there are few reports at present.We analyzed the clinical and pathological features of 7 patients with GB-NEC who were admitted to Zhejiang Provincial People's Hospital from January 2011 to October 2019.The median age of 7 patients was 58 years with male to female ratio of 1:2.5. Right upper quadrant discomfort was the main complaint and no patients presented carcinoid syndrome-related symptoms. In contrast-enhanced computed tomography (CT) examination, 5 of 6 patients showed well-defined margin and continuous thin line-like contrast enhancement on the mucosa. Among the patients with liver metastases before surgery, 66.7% of patients were cancer antigen 125 (CA-125) positive, and among the patients presented with liver metastases during follow-up period, all patients were CA-125 positive. All patients with elevated CA-125 did not have ascites, ovarian carcinoma, peritoneal carcinoma, and endometrial carcinoma. According to postoperative pathological report, 1 patient was stage IIIA, and the other 6 patients were stage IVB. Six patients underwent surgery, and 1 patient just underwent liver biopsy. Two patients underwent laparoscopic radical cholecystectomy, and neither of them encountered serious complications after surgery with the overall survival time of 4.6 and 16.8 months, respectively. Compared with the patients without chemotherapy, 3 patients postoperatively treated with chemotherapy lived longer. The median survival of all 7 patients was 4.6 months and the 1-, 2-year survival rates were 14.29%, 0%.Surgical resection, including laparoscopic radical cholecystectomy, is feasible for the treatment of advanced GB-NEC in selected patients and has the advantages of prolonging survival in combination with chemotherapy. The elevation of CA-125 can be utilized as an important predictor of poor prognosis, while more investigations are necessary to confirm it.

Peritoneal tuberculosis is a disease which can mimick malignancy especially in women who present with ascites and elevated CA125 levels. It should always be considered in differential diagnosis, but the diagnosis is rarely easy for clinicians. A young female patient who presented with abdomen tenderness and diagnosed with peritoneal tuberculosis as a result of performed tests is discussed hereby in the case report. We expect that this case report adds to the existing literature on this subject.

We report a case of paradoxical worsening of tuberculous chorioretinitis after initiation of anti-tuberculous therapy (ATT). The patient had left panuveitis with tuberculous chorioretinitis and was started on systemic ATT and oral steroids a week later. However, he developed paradoxical worsening 2 months after initiation of therapy. He was continued on ATT, oral steroids and intravitreal amikacin with resolution of the chorioretinal lesion subsequently. Ocular tuberculosis often poses a diagnostic challenge, and clinicians should be aware of the possibility of paradoxical worsening despite appropriate ATT. Clinicians should strongly consider starting oral steroids concurrently with ATT when managing ocular tuberculosis.

Introduction: A struma ovarii is a benign monodermal teratoma, composed of mature thyroid tissue. The presentation of this disease with pseudo-Meigs’ syndrome [characterized by ascites, pleural effusions, and elevated cancer antigen-125 (CA-125) levels] may result in an advanced ovarian cancer misdiagnosis. Case Presentation: The patient was a 54-year-old woman with dyspnea, abdominal distention, and pseudo-Meigs’ syndrome. She had a final diagnosis of struma ovarii, misdiagnosed as advanced ovarian cancer. She is currently asymptomatic (after surgery) and has a normal CA-125 level. Conclusions: The preoperative diagnosis of struma ovarii is difficult, and if it presents with pseudo-Meigs’ syndrome, it may be initially misdiagnosed as advanced ovarian cancer. Using the frozen-section procedure, unnecessary extensive surgeries can be prevented.

Background: Peritoneal Tuberculosis (TB) is a rare and challenging pathology that can present with ascites but seldom with hemorrhagic ascites. Diagnosis can be challenging owing to nonspecific symptoms and variable result imaging techniques. TB could occur primarily or extrapulmonary with intraabdominal TB accounting for one of the rare forms of extra-pulmonary TB. Abdominal TB can affect any part of the gastrointestinal system with the ileum being the commonest, however, affection of the peritoneum is rare coupled with the fact that hemorrhagic effusion is also a rare presentation; this has resulted in a diagnostic challenge even to the astute surgeon. Aim and Objective: We reported this to highlight the need for vigilance and a high index of suspicion in TB Endemic areas for prompt diagnosis of Intraabdominal TB to prevent Morbidity and mortality. Case Summary: A 31year Hausa Muslim Man, who presented to the Emergency unit with the complaint of a 6months history of recurrent abdominal pain, that is vague with no known aggravating or relieving factors with associated low-grade fever, progressive weight loss, generalized body weakness and anorexia. Three weeks before presentation symptoms worsen with associated progressive abdominal distention, constipation and vomiting of several bouts per day non bilious, non-projectile containing recently ingested feeds. Abdominal Examination findings revealed ascites with features of peritonitis. He was resuscitated and had laparotomy with intraoperative findings of haemorrhagic ascites of 3 litres, and extensive miliary deposits on all the abdominal viscera, abdominal wall, and omentum. No mesenteric lymph nodes. He had an uneventful post-operative recovery. Histology report and ascitic fluid cytology showed chronic granulomatous inflammation and inflammation respectively. He was commenced on intensive phase of anti TB medication with clinical improvement. Conclusion: Hemorrhagic ascites from peritoneal TB could portend a grave sign, but prompt diagnosis and treatment could have a rewarding outcome.

<h3>Introduction/Background*</h3> Ovarian cancer is the leading cause of mortality from gynaecological malignancy. Survival improves with early diagnosis, however, early detection in primary care is challenging. The current blood test, cancer antigen 125 (CA125), has limited sensitivity and specificity for early disease. Human Epididymis 4 (HE4) is a promising diagnostic biomarker. We aimed to investigate the diagnostic accuracy and clinical utility of serum HE4 in a symptomatic primary care population. <h3>Methodology</h3> We conducted a prospective observational study testing HE4 on primary care serum CA125 samples from women with suspected ovarian cancer in Manchester, UK, between April 2018 and April 2019. Serum HE4 was measured using chemiluminescent enzyme immunoassays following routine CA125 testing for clinical care. HE4 thresholds of 77pmol/L and 150pmol/L were used. The primary outcome was final diagnosis within 12 months of testing. Clinical outcomes were collected from hospital electronic patient records. Receiver operator characteristic (ROC) curves with area under the curve (AUC), sensitivity and specificity were calculated for CA125 and HE4 both alone and in combination. Age adjusted HE4 thresholds were calculated with linear regression models. <h3>Result(s)*</h3> 1247 patients were included, with a mean age of 50 years (SD 15.7). 100 women had epithelial ovarian cancer; including 82 invasive and 18 borderline ovarian tumours. There was little difference in overall performance of CA125 and HE4 (AUC 0.932 vs 0.914 respectively). At a threshold of 77pmol/L, HE4 alone had a better sensitivity than CA125 [89% (95%CI 81.2-94.4) vs 81% (95% CI 71.9-88.2)] but a worse specificity [75.6% (95%CI 73-78) vs 92.2% (95%CI 90.4-93.6)]. HE4 and CA125 combined had improved sensitivity compared with CA125 alone (93%, 95%CI 86.1-97.1), but at a significant cost to specificity (70%, 95%CI 67.3-72.6). Serum HE4 levels were correlated with increasing age (p &lt;0.001) and worsening eGFR (p&lt;0.001). Age adjusted HE4 cut-offs marginally improved the specificity of CA125, however the numbers were small per age category and require validation in larger cohorts. <h3>Conclusion*</h3> HE4 adds little to current diagnostic pathways in primary care. Age-adjusted thresholds may improve accuracy, but not sufficiently to recommend routine use at present.

Colloid carcinoma (CC) of the pancreas, also known as mucinous non-cystic carcinoma, is a rare histological variant of pancreatic cancer. The present study reports the case of a 65-year-old male with a pancreatic head tumor 4.6×3.1 cm in size. The tumor had not invaded the superior mesenteric or celiac arteries. Laboratory data showed elevated alkaline phosphatase, γ-gluytamyl transpeptidase and cancer antigen 19-9 (CA19-9) levels. The patient underwent a pancreaticoduodenectomy (PD), and the pathology revealed CC extending to the submucosa of the duodenum, with mild atypical hyperplasia of the pancreatic duct. The patient was negative for circulating tumor cells, indicating a good prognosis. The CA19-9 concentration decreased to within the normal range following surgery. The present study reports a rare case of CC of the pancreas presenting with obstructive jaundice, in which a PD procedure was performed. Primary surgical treatment with curative intent is the optimal management and this subtype of pancreatic cancer is associated with a better prognosis compared with pancreatic ductal adenocarcinoma.

Abdominal tuberculosis (TB), particularly peritoneal TB, is a rare and challenging form of extra-pulmonary TB that often presents with nonspecific symptoms, leading to diagnostic difficulties and treatment delays.This case report highlights the diagnostic challenges of peritoneal tuberculosis (TB) in a 22-year-old Sudanese male presenting with nonspecific symptoms, such as abdominal pain, fever, and weight loss.Imaging revealed ascites, para-aortic lymphadenopathy, and omental thickening.Despite negative Ziehl-Neelsen staining, diagnostic laparoscopy and peritoneal biopsy confirmed TB through granulomatous inflammation.The report emphasizes the importance of considering peritoneal TB in endemic areas and utilizing laparoscopy for diagnosis when conventional microbiological methods fail.Early diagnosis and treatment initiation are crucial for improved patient outcomes.

Interest in screening for ovarian cancer, which is common in developed countries, has grown in recent years. This study, which seems to be the first prospective randomized report of ovarian cancer screening, was designed to establish a better strategy for detecting early cancers. Asymptomatic postmenopausal women, seen in the years 1985 to 1999, were randomly assigned to an intervention group (n = 41,688) or to a control group (n = 40,799) and were followed up for an average of 9.2 years. The original goal was to offer annual screens comprising pelvic ultrasonography and a serum cancer antigen 125 (CA-125) test to women in the intervention group. Those with abnormal ultrasound findings or elevated CA-125 were referred to a gynecologic oncologist for surgical assessment. In late 2002 when the code was broken, 27 cancers were found in screened women and 8 more were diagnosed outside the screening program. Rates of detecting ovarian cancer were 0.31 per 1000 at the prevalent screen and ranged from 0.38 to 0.74 per 1000 at subsequent screens. Rates increased on successive screens. Ovarian cancer developed in 32 control women. Fewer women in the screened group than in the control group had advanced-stage disease. The proportion of stage I ovarian cancer was higher in screened than in control women (63% vs. 38%), but the difference fell short of statistical significance. The histologic type of index cancers was similar in the screened and control groups, as were tumor grade and the use of adjuvant chemotherapy. More women in the screening group than in the control group had no disease or only microscopic disease, but this difference also was not statistically significant. Continuing follow-up of this cohort is expected to provide further information about the effects of screening for ovarian cancer on asymptomatic postmenopausal women.

BackgroundNew-onset atrial fibrillation (NOAF) is the most commonly encountered arrhythmia during the course of acute myocardial infarction (AMI) and is independently associated with a worse prognosis.AimsWe aimed to validate the discriminatory performance of cancer antigen-125 (CA-125) in predicting post-AMI NOAF in the Chinese population.MethodsA total of 488 consecutive patients with AMI from 1 January 2020 to 1 January 2022 without a previous history of AF were enrolled in this study. Risk factors for post-AMI NOAF were determined using univariable and multivariable logistic regression analyses. Receiver operating characteristic (ROC) curve analyses were used to evaluate the discrimination performance of different parameters and score models. Area under the curve (AUCs) were compared using Z tests.ResultsIn total, 48 (9.84%) patients developed post-AMI NOAF during hospitalization. The NOAF group was older and had a higher Killip class, B-type natriuretic peptide level, CA-125 level, left atrial diameter, left ventricular end-systolic diameter, CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 years [2 points], Diabetes mellitus, Stroke/transient ischemic attack/thromboembolism history [2 points], Vascular disease, Age 65–74 years, Sex category [female]) score, Global Registry of Acute Coronary Events (GRACE) risk score (RS), and in-hospital mortality, and a lower low-density lipoprotein level, left ventricular ejection fraction, and initial β-receptor blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use (P < 0.05 vs. the no-NOAF group for all measures). In the multivariate regression analyses, CA-125 remained an independent risk factor for post-AMI NOAF in different models. In the ROC curve analyses, CA-125 (AUC = 0.753, 95% CI: 0.665–0.84, P < 0.001), GRACE RS (AUC = 0.701, 95% CI: 0.593–0.809, P = 0.001), and CHA2DS2-VASc score (AUC = 0.644, 95% CI: 0.532–0.757, P = 0.014) were valid tools to predict post-AMI NOAF. After Z tests, the discriminatory performance of CA-125 was significantly higher than that of the CHA2DS2-VASc score (P = 0.038), but not statistically significantly higher than that of the GRACE RS (P = 0.353).ConclusionAn elevated plasma CA-125 level was independently associated with NOAF after AMI, with high discriminatory performance.

A rare case report of recurrent metastatic breast cancer mimicking primary pancreatic cancer