Submucosal tumor-like lesion originating from colon tuberculosis: a case report and review of the literature

Abstract

A 76-year-old male had a solitary submucosal tumor-like lesion in the sigmoid colon originating from tuberculosis. The lesion, up to 1 cm in diameter, was found incidentally during a routine colonoscopy, which revealed a protuberant submucosal growth with a shallow depression of the overlying mucosa in the center of the tumor. Histologically, the endoscopic biopsy revealed caseating granulomas and infiltration of Langhans giant cells and epithelioid cells, consistent with tuberculosis, were also observed. Five reports of similar lesions from colon tuberculosis were found in a literature review, including the present case. In all cases, the submucosal tumor-like lesions which originated from tuberculosis were small and in an active stage of tuberculosis. Five cases of submucosal tumor-like lesions from gastric tuberculosis were also reported, with characteristics very similar to those of the lesions from colon tuberculosis. Therefore, we propose that lesions originating from tuberculosis should be included in the differential diagnosis of submucosal tumor-like lesions in the colon and stomach.

More Than Just a Polyp: Diagnosis of Tuberculosis From a Screening Colonoscopy

“…Diagnosis of colonic TB can be done by colonoscopy combined with histopathologic and bacteriologic examination. Findings on colonoscopy can range from non-specific ulcerations, nodular lesions, strictures, and, less commonly, polyps [4,7,8,14,15]. These nondescript endoscopic findings make colonic TB easily mistaken with other colonic pathologies such as Crohn's disease and malignancy leading to significant delays in the diagnosis and management as well as unnecessary surgical interventions.…”

“…These nondescript endoscopic findings make colonic TB easily mistaken with other colonic pathologies such as Crohn's disease and malignancy leading to significant delays in the diagnosis and management as well as unnecessary surgical interventions. The histopathologic examination usually reveals caseating epithelioid granulomas which are very specific for TB [7,8,14]. One retrospective study of 50 patients with colonic TB from India reported that granulomas were seen only in 18% of cases, and caseation was not detected in any case.…”