Coexisting Bronchogenic Carcinoma and Pulmonary Tuberculosis in the Same Lobe: Radiologic Findings and Clinical Significance

Abstract

ObjectiveBronchogenic Carcinoma Can Mimic Or Be Masked By Pulmonary Tuberculosis (Tb), And The Aim Of This Study Was To Describe The Radiologic Findings And Clinical Significance Of Bronchogenic Carcinoma And Pulmonary Tb Which Coexist In The Same Lobe.Materials and MethodsThe findings of 51 patients (48 males and three females, aged 48-79 years) in whom pulmonary TB and bronchogenic carcinoma coexisted in the same lobe were analyzed. The morphologic characteristics of a tumor, such as its diameter and margin, the presence of calcification or cavitation, and mediastinal lymphadenopathy, as seen at CT, were retrospectively assessed, and the clinical stage of the lung cancer was also determined. Using the serial chest radiographs available for 21 patients, the possible causes of delay in the diagnosis of lung cancer were analyzed.ResultsLung cancers with coexisting pulmonary TB were located predominantly in the upper lobes (82.4%). The mean diameter of the mass was 5.3 cm, and most tumors (n=42, 82.4%) had a lobulated border. Calcification within the tumor was seen in 20 patients (39.2%), and cavitation in five (9.8%). Forty-two (82.4%) had mediastinal lymphadenopathy, and more than half the tumors (60.8%) were at an advanced stage [IIIB (n=11) or IV (n=20)]. The average delay in diagnosing lung cancer was 11.7 (range, 1-24) months, and the causes of this were failure to observe new nodules masked by coexisting stable TB lesions (n=8), misinterpretation of new lesions as aggravation of TB (n=5), misinterpretation of lung cancer as tuberculoma at initial radiography (n=4), masking of the nodule by an active TB lesion (n=3), and subtleness of the lesion (n=1).ConclusionMost cancers concurrent with TB are large, lobulated masses with mediastinal lymphadenopathy, indicating that the morphologic characteristics of lung cancer with coexisting pulmonary TB are similar to those of lung cancer without TB. The diagnosis of lung cancer is delayed mainly because of masking by a tuberculous lesion, and this suggests that in patients in whom a predominant or growing nodule is present and who show little improvement of symptoms despite antituberculous or other medical therapy, coexisting cancer should be suspected.

A 2-year retrospective review of the effect of cigarette smoking status on the histological cell types of lung carcinoma in the Western Cape

“…Korean data suggest that this problem is not isolated to SA, as they too have a high prevalence of tuberculosis. [51] The Korean data found an average delay of 11.7 months in diagnosing lung cancer for similar reasons to those mentioned previously. [51] We believe that our study has definite clinical application.…”

“…[51] The Korean data found an average delay of 11.7 months in diagnosing lung cancer for similar reasons to those mentioned previously. [51] We believe that our study has definite clinical application. Owing to the large number of females with lung cancer in our sample and their rising mortality rates in our country, more should be done by clinicians to try and inform females of this problem.…”

Pulmonary tuberculosis increases the risk of lung cancer

“…17,18 In addition, the coexistence of TB and lung cancer has been observed for decades, and poses significant challenges for the diagnosis and treatment of both diseases. [19][20][21] When there is occult lung cancer or the coexistence of TB and lung cancer, this would magnify the lung cancer risk during the first year of TB infection. To focus specifically on the risk of lung cancer after pulmonary TB infection, lung cancer diagnosis before or within the first year of TB infection was excluded to lessen the possibility of reverse causality and coexistence.…”

Response of pulmonary tuberculomas to anti-tuberculous treatment

“…The diagnosis of a pulmonary tuberculoma remains a challenge, not only because it usually requires an invasive procedure, such as percutaneous needle aspiration or open thoracotomy, but also because it may be accompanied by malignancy in rare cases [15,24,25]. In this context, it is essential for the clinician to be aware of the treatment response of tuberculomas.…”