The great imitator: miliary peritoneal tuberculosis mimicking Stage III ovarian carcinoma

Purpose: To report a case of peritoneal tubercolosis initially mistaken at the time of surgery for metastatic ovarian carcinoma. Case Report: A 31-year-old Filipino female was found to have increasing abdominal pain, ascites, early satiety, increasing abdominal girth and bilateral complex masses. Diagnostic laparoscopy revealed the presence of > 4 liters of ascites, a frozen pelvis secondary to what appeared to be bilateral ovarian carcinomas, along with miliary seeding of the entire anterior abdominal wall, omentum, small bowel and small bowel mesentery, right and left diaphragmatic surfaces, and hepatic surface. Frozen section, at the time of laparotomy, revealed necrotizing granulomas most consistent with disseminated tuberculosis that was confirmed at the time of final pathologic review and culture. Conclusion: Peritoneal tuberculosis can be mistaken for widely metastatic ovarian carcinoma at time of surgery.