GRANULOMATOUS DISEASE OF PERITONEUM MIMICKING CLINICALLY A PERITONEAL CARCINOMATOSIS.
A 52 year-old woman, with a background of surgery by pelvic endometriosis two years before, was submitted for showing symptoms of abdominal distension with pseudo obstructive episodes and malaise. Apart from endometriosis, there was no a history of chronic inflammatory diseases or other interesting pathological events. At the physical exam, ascites is discovered coinciding with radiological study by abdominal scan (SC), which reveals multiple and heterogeneous nodules at the peritoneal surface. The clinical diagnosis was of peritoneal carcinomatosis. A laparoscopic study was realized in which no other abdominal abnormalities were perceived apart from the irregular peritoneal thickening, suggesting tumour process. Two biopsies of different nodules were made. During histological exam, no neoformative tissue was found. On the contrary, the global alteration consisted of multiple isolated or confluent epithelioid granulomas in a fibrotic background. Basically they were made of histiocyte aggregates and less often multinucleated giant cells. Neither central necrosis nor characteristically morphological signs concerning to specific inflammatory disorders were seen. Specific stains such as Ziehl-Neelsen, Periodic Acid Schiff, Giemsa or Methenamine Silver did no visualized pathogen germs. In addition, in order to rule out tuberculosis, a PCR for BK bacilli was also negative. After the fact that specific aetiologies were discarded, the patient is being treated by anti-inflammatories and she is having a slow but good response.
