Clinical presentation of abdominal tuberculosis in HIV seronegative adults

BACKGROUND: The accurate diagnosis of abdominal tuberculosis usually takes a long time and requires a high index of suspicion in clinic practice. Eighty-eight immune-competent patients with abdominal tuberculosis were grouped according to symptoms at presentation and followed prospectively in order to investigate the effect of symptomatic presentation on clinical diagnosis and prognosis. METHODS: Based upon the clinical presentation, the patients were divided into groups such as non-specific abdominal pain & less prominent in bowel habit, ascites, alteration in bowel habit, acute abdomen and others. Demographic, clinical and laboratory features, coexistence of pulmonary tuberculosis, diagnostic procedures, definitive diagnostic tests, need for surgical therapy, and response to treatment were assessed in each group. RESULTS: According to clinical presentation, five groups were constituted as non-specific abdominal pain (n = 24), ascites (n = 24), bowel habit alteration (n = 22), acute abdomen (n = 9) and others (n = 9). Patients presenting with acute abdomen had significantly higher white blood cell counts (p = 0.002) and abnormalities in abdominal plain radiographs (p = 0.014). Patients presenting with alteration in bowel habit were younger (p = 0.048). The frequency of colonoscopic abnormalities (7.5%), and need for therapeutic surgery (12.5%) were lower in patients with ascites, (p = 0.04) and (p = 0.001), respectively. There was no difference in gender, disease duration, diagnostic modalities, response to treatment, period to initial response, and mortality between groups (p > 0.05). Gastrointestinal tract alone was the most frequently involved part (38.5%), and this was associated with acid-fast bacteria in the sputum (p = 0.003). CONCLUSION: Gastrointestinal tract involvement is frequent in patients with active pulmonary tuberculosis. Although different clinical presentations of patients with abdominal tuberculosis determine diagnostic work up and need for therapeutic surgery, evidence based diagnosis and consequences of the disease does not change

The prediction of para-aortic lymph node metastasis in endometrioid adenocarcinoma of endometrium

The aim of this study was to assess factors associated with para-aortic lymph node metastasis in endometrioid adenocarcinoma. The data of 157 patients with endometrioid adenocancer, who underwent staging surgery, was reviewed retrospectively. A total of 23 patients (14.6%) had pelvic and 19 patients (12.1%) had para-aortic lymph node metastasis; 21% (4/19) of the patients with para-aortic lymph node involvement did not have pelvic lymph node metastasis. Para-aortic lymph node involvement was significantly more common in the presence of LVSI and pelvic lymph node metastasis, and pelvic lymph node metastasis was the only independent risk factor for para-aortic lymph node involvement. The sensitivity and NPV of positive pelvic lymph node in the prediction of para-aortic lymph node metastasis were found to be 78.9% and 97%, respectively. The corresponding rates for obturator and/or external iliac lymph node were 63.1% and 95%, respectively. In conclusion, although pelvic lymph node metastasis is the only independent risk factor for para-aortic lymph node involvement, negative pelvic lymph node is not enough to omit para-aortic lymph node dissection. On the other hand, intraoperative frozen section examination of obturator and/or external iliac lymph node to omit para-aortic lymphadenectomy might be a good option for the patients who have high medical risks for surgery

Benign multicystic peritoneal mesothelioma mimicking recurrence of an ovarian borderline tumor: a case report

<p>Abstract</p> <p>Introduction</p> <p>Benign multicystic peritoneal mesothelioma is an extremely rare tumor that occurs mainly in women in their reproductive age. Its preoperative diagnosis and adequate treatment are quite difficult to attain.</p> <p>Case presentation</p> <p>Our patient was a 23-year-old Japanese woman who had a history of right oophorectomy and left ovarian cystectomy for an ovarian tumor at 20 years of age. The left ovarian tumor had been diagnosed on histology as a mucinous borderline tumor. Two years and nine months after the initial operation, multiple cysts were found in our patient. A laparotomy was performed and her uterus, left ovary, omentum and pelvic lymph nodes were removed due to suspicion of recurrence of the borderline tumor. A histological examination, however, revealed that the cysts were not a recurrence of the borderline tumor but rather benign multicystic peritoneal mesothelioma. There were no residual lesions and our patient was followed up with ultrasonography. She remains free from recurrence nine months after treatment.</p> <p>Conclusion</p> <p>We report a case of benign multicystic peritoneal mesothelioma mimicking recurrence of an ovarian borderline tumor. Benign multicystic peritoneal mesothelioma should be suspected when a multicystic lesion is present in the pelvis as in the case presented here, especially in patients with previous abdominal surgery.</p