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Hu M. A Case of Multi-Organ Tuberculosis Misdiagnosed as Lung Cancer and a Literature Review. Cancer Manag Res 2023; 15:1395-1400. [PMID: 38161787 PMCID: PMC10757780 DOI: 10.2147/cmar.s433226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
Background Tuberculosis (TB) is a very common and easily diagnosed as a malignancy. However, studies have described the difference between TB and lung cancer. Single-organ TB and lung cancer are often easily distinguished clinically. Atypical systemic hematogenous disseminated TB (HDTB) is uncommon, including rare cases involving multiple organs such as cervical lymph nodes, pleura, liver, and lung TB simultaneously, which are more confusing and easily misdiagnosed in clinical practice. Case Presentation A HIV-negative 56-year-old male was hospitalized for chest disease with main symptoms of chest tightness, chest pain, fatigue, anorexia, and weight loss. Heart rate 109 times/min, the computed tomography (CT) scans of the neck, chest, and abdomen revealed multiple nodules in the right pleura, right pleural encapsulated effusion, and limited, incomplete expansion of the middle and lower lobes of the right lung, enlarged lymph nodes in the right hilar and mediastinal and diaphragm groups, and multiple slightly low-density nodules in the liver, bone destruction in the 2nd thoracic vertebra, raising the possibility of multiple liver metastases of right lung cancer and malignant pleural fluid. The lymph nodes in the neck, mediastinum, abdomen, and pelvis were enlarged bilaterally. After comprehensive analysis, the patient was diagnosed with atypical systemic HDTB. After three months of conventional anti-TB treatment, the patient refused our hospital follow-up, and his symptoms improved significantly during the telephone follow-up. Conclusion Most previous TB misdiagnoses involved a single organ, and this case enriches the clinical experience of diagnosing atypical HDTB. We encourage clinicians to establish a dynamic diagnostic and therapeutic mindset, emphasizing the value of biopsy and pathology.
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Affiliation(s)
- Meng Hu
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, People’s Republic of China
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Hu N, Wu Y, Tang M, Luo T, Yuan S, Li C, Lei P. Case report: Hepatic tuberculosis mimicking hepatocellular carcinoma in a patient with cirrhosis induced by hepatitis B virus. Front Med (Lausanne) 2022; 9:1005680. [PMID: 36457572 PMCID: PMC9705775 DOI: 10.3389/fmed.2022.1005680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/25/2022] [Indexed: 08/30/2023] Open
Abstract
Hepatic tuberculosis (TB), which is secondary to post-hepatitis B cirrhosis, is extremely rare. We report the case of a 69-year-old man with post-hepatitis B cirrhosis complicated by primary isolated hepatic TB who was initially misdiagnosed as having hepatocellular carcinoma (HCC). The patient was hospitalized with complaints of 2 weeks of fever. He had a 20-year history of post-hepatitis B cirrhosis. The laboratory tests suggested that his serum alpha-fetoprotein (AFP) level was markedly elevated to 1210 ng/ml. From the abdominal ultrasound (US) and magnetic resonance imaging (MRI) images, we confirmed the presence of cirrhosis and discovered a space-occupying lesion of the hepatic left lobe as well as portal vein-filling defects. These results led us to consider primary liver cancer and portal vein tumor thrombus combined with decompensated cirrhosis. Biopsy and histology may be considered the ultimate diagnostic tests, but we excluded needle biopsy because of his high risk of bleeding, in addition, the patient declined the procedure. To cope with his fever, the patient was given broad-spectrum antibiotic treatment initially, followed by intravenous vancomycin. After antibiotic treatment had failed, the patient was treated with anti-TB for 10 days; after that, the patient maintained a normal temperature. The patient continued to receive tuberculostatic therapy for 6 months following his discharge. AFP completely returned to the normal level, and the aforementioned mass disappeared. Finally, hepatic TB secondary to post-hepatitis B cirrhosis with portal vein thrombosis (PVT) was considered to be the final diagnosis. More than two imaging techniques discover a space-occupying liver lesion and that the serum alpha-fetoprotein (AFP) level is extremely elevated, which means that hepatocellular carcinoma (HCC) could be diagnosed. However, some exceedingly rare diseases should not be excluded. This case illustrated that the non-invasive diagnostic criteria for liver cancer should be considered carefully when discovering a space-occupying liver lesion in a patient with cirrhosis and an elevated AFP level. In addition, primary hepatic TB should be considered and included in the differential diagnosis, and a biopsy should be performed promptly.
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Affiliation(s)
- Na Hu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yuhui Wu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Maowen Tang
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Tianyong Luo
- Department of Infection, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shengmei Yuan
- Department of Ultrasound Center, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Cai Li
- Department of Infection, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Pinggui Lei
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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'Hepatic tuberculosis: a sheep in wolf's clothing'. Author response. Hepatol Int 2022; 16:475-476. [PMID: 35141863 DOI: 10.1007/s12072-022-10297-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/31/2021] [Indexed: 11/04/2022]
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Li W, Tang YF, Yang XF, Huang XY. Misidentification of hepatic tuberculosis as cholangiocarcinoma: A case report. World J Clin Cases 2021; 9:9662-9669. [PMID: 34877304 PMCID: PMC8610856 DOI: 10.12998/wjcc.v9.i31.9662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/28/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic tuberculosis (TB) is uncommon clinically. Because of a lack of specific signs, characteristic symptoms and clinical manifestations and because pathological samples are difficult to obtain, hepatic TB is easily missed or misdiagnosed.
CASE SUMMARY A 62-year-old Chinese man presented with jaundice for 1 wk and no abnormal laboratory tests other than elevated bilirubin, aminotransferases and C-reactive protein. Computed tomography (CT) of the abdomen showed a mass in the left lobe of the liver and hepatic hilum with striped calcified foci. Mild enhancement was visible at the edges, along with extensive intrahepatic biliary ductal dilatation in the right lobe of the liver. In the arterial phase of both CT and magnetic resonance imaging, the main trunk and right branch of the portal artery were partially visualized. Magnetic resonance cholangiopancreatography (MRCP) indicated that the left lobe of the liver and most of the bile ducts in the hilum were not visible. Pathological examination revealed coagulative necrosis, and granulomatous nodules were seen around areas of necrosis; therefore, TB was considered.
CONCLUSION Hepatic tuberculosis is easily misdiagnosed or missed on imaging. Percutaneous puncture biopsy is the most useful tool for definitive diagnosis.
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Affiliation(s)
- Wei Li
- The Affiliated Nanhua Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China
| | - Yan-Fen Tang
- The Affiliated Nanhua Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China
| | - Xue-Feng Yang
- The Affiliated Nanhua Hospital, Department of Gastroenterology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China
| | - Xiang-Yu Huang
- The Affiliated Nanhua Hospital, Department of Radiology, Hengyang Medical School, University of South China, Hengyang 421002, Hunan Province, China
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Abstract
BACKGROUND AND AIMS Hepatic tuberculosis (HTB) is rare and mimics neoplastic liver lesions clinico-radiologically leading to misdiagnosis and even unnecessary surgery. METHODS AND MATERIAL We analysed 43 cases of HTB diagnosed at a referral cancer centre over 10 years. Clinical details, investigations and treatment received were noted. RESULTS The median age was 46 years with a female preponderance (58%). HTB was diagnosed incidentally in 28% cases during surveillance imaging for a previous cancer. Constitutional symptoms (31, 72%), abdominal pain (25, 58%), fever (12, 28%), hepatomegaly (22, 51%), elevated alkaline phosphatase (34, 79%), elevated aminotransferases (18, 42%) and hypoalbuminemia (19, 45%) were common features. All cases had negative HIV serology and normal tumor markers. Twenty-two (52.5%) had solitary liver lesion and lesions > 2 cm in 28 (65%). Ultrasound showed hypoechoic lesions in 31 of 33 cases. Computed tomography showed hypodense lesions (43,100%) with mild peripheral enhancement (32, 74%). Calcifications (5, 12%) and capsular retraction (8, 19%) was uncommon. MRI was performed in seven cases commonly showed T1 hypointense, T2 hyperintense lesions with restricted diffusion. Histopathology showed granulomatous inflammation (42, 97.5%), Langhan's giant cells (41, 95%) and caseation necrosis (35, 85%). Acid-fast stain and PCR positivity was uncommon. Extrahepatic organs were involved in 20 (46.5%). HTB mimicked cholangiocarcinoma (25, 58%), liver metastasis (11, 26%) and lymphoma (3, 7%). Six patients underwent liver resection with a presumptive diagnosis of cancer without a preoperative biopsy. All patients received antitubercular therapy, 37 had clinico-radiological response, there were 3 deaths and 3 patients were lost to follow-up. CONCLUSION HTB is rare and can mimic a malignancy clinico-radiologically. Calcifications and pseudocapsule appearance on multiphase CT scan may help in differentiating HTB from hepatic malignancy. Tumor markers are normal while histopathology is generally diagnostic. A high index of suspicion is required to avoid unnecessary surgery as the patients respond well to ATT. TRIAL REGISTRATION This is a retrospective and observational study hence clinical trial registration is not applicable.
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Ahmad B, Ahmad T, Ahmad A, Ahmad M. Liver segmentectomy surgery for delayed diagnosed hepatic TB, a case report from Syria. Ann Med Surg (Lond) 2021; 65:102302. [PMID: 33948173 PMCID: PMC8079956 DOI: 10.1016/j.amsu.2021.102302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance: Mycobacterium Tuberculosis infection is still one of the most common causes of morbidity and mortality worldwide. TB usually infects the lungs, but it can affect other organs. Hepatic involvement usually occurs with disseminated disease whereas isolated hepatic involvement is extremely rare. Case presentation: We present a case of a female patient who had to undergo major hepatic surgery due to delayed diagnosis of hepatic TB. It suffered from recurrent abdominal abscesses and general symptoms for a period of time. clinical Discussion: Medical therapy is the treatment of choice and surgery is justified only in specific cases. Surgical intervention may range from less complicated procedures as local excision, abscess drainage or biliary drainage to more complicated and major surgeries such as liver segmentectomy and hemihepatectomy. conclusion: Although rare, physicians should suspect and diagnose early, to give the patient the best chance to benefit from medical therapy and avoid the need for surgical intervention.
Although rare, hepatic TB still occurs with no specific symptoms or imaging study making it challenging. Surgical intervention may range from less complicated procedures to more complicated and major surgeries. The delayed decision to refer to a tertiary hospital for other options of treatment made her quality of life poor.
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Affiliation(s)
- Basel Ahmad
- General Surgery Resident, Faculty of Medicine, Damascus University, Syria
| | - Tareq Ahmad
- Oncology Resident, Faculty of Medicine, Damascus University, Syria
| | - Aya Ahmad
- Medical Student, Faculty of Medicine, Damascus University, Syria
| | - Mohamad Ahmad
- Head of Surgery Department, Faculty of Medicine, Damascus University, Chief of Liver Transplant Team, Al Assad University Hospital, Damascus, Syria
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Niyogi D, Goel M, Shinde RS, Patkar S. Primary hepatic tuberculosis: A rare occurrence. Ann Hepatobiliary Pancreat Surg 2019; 23:80-83. [PMID: 30863814 PMCID: PMC6405358 DOI: 10.14701/ahbps.2019.23.1.80] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/14/2018] [Accepted: 10/22/2018] [Indexed: 11/26/2022] Open
Abstract
Primary hepatic tuberculosis is a rare entity and can closely mimic malignancy with respect to clinical presentation and imaging features. We identified five patients at a high volume tertiary care cancer center, whose clinical features and imaging closely mimicked primary liver malignancy or metastases but final histopathology was suggestive of hepatic tuberculosis. Three patients underwent a surgical resection whereas two were diagnosed on a biopsy. Anti-tuberculosis therapy was started for all the patients which was well tolerated. All patients are doing well at the time of the last follow up. This case series stresses the importance of having a high index of suspicion and preoperative biopsy in cases where imaging features are equivocal.
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Affiliation(s)
- Devayani Niyogi
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Mahesh Goel
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Rajesh S Shinde
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shraddha Patkar
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, India
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9
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Kritsaneepaiboon S, Andres MM, Tatco VR, Lim CCQ, Concepcion NDP. Extrapulmonary involvement in pediatric tuberculosis. Pediatr Radiol 2017; 47:1249-1259. [PMID: 29052770 DOI: 10.1007/s00247-017-3867-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 02/23/2017] [Accepted: 04/09/2017] [Indexed: 12/17/2022]
Abstract
Tuberculosis in childhood is clinically challenging, but it is a preventable and treatable disease. Risk factors depend on age and immunity status. The most common form of pediatric tuberculosis is pulmonary disease, which comprises more than half of the cases. Other forms make up the extrapulmonary tuberculosis that involves infection of the lymph nodes, central nervous system, gastrointestinal system, hepatobiliary tree, and renal and musculoskeletal systems. Knowledge of the imaging characteristics of pediatric tuberculosis provides clues to diagnosis. This article aims to review the imaging characteristics of common sites for extrapulmonary tuberculous involvement in children.
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Affiliation(s)
- Supika Kritsaneepaiboon
- Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Thailand.
| | - Mariaem M Andres
- Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines
| | - Vincent R Tatco
- Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines
| | - Cielo Consuelo Q Lim
- Institute of Radiology, St. Luke's Medical Center, 279 E. Rodriquez Sr. Boulevard, 1102, Quezon City, Philippines
| | - Nathan David P Concepcion
- Institute of Radiology, St. Luke's Medical Center, 32nd Avenue corner 5th Street, Bonifacio Global City, 1634, Taguig City, Philippines
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Evans RPT, Mourad MM, Dvorkin L, Bramhall SR. Hepatic and Intra-abdominal Tuberculosis: 2016 Update. Curr Infect Dis Rep 2016; 18:45. [PMID: 27796776 DOI: 10.1007/s11908-016-0546-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mycobacterium tuberculosis (TB) infection affects nearly 10 million people a year and causes 1.5 million deaths. TB is common in the immunosuppressed population with 12 % of all new diagnoses occurring in human immune deficiency virus (HIV)-positive patients. Extra-pulmonary TB occurs in 12 % of patients with active TB infection of which 3.5 % is hepatobiliary and 6-38 % is intra-abdominal. Hepatobiliary and intra-abdominal TB can present with a myriad of non-specific symptoms, and therefore, diagnosis requires a high level of suspicion. Accurate and rapid diagnosis requires a multidisciplinary team (MDT) approach using radiology, interventional radiology, surgery and pathology services. Treatment of TB is predominantly medical, yet surgery plays an important role in managing the complications of hepatobiliary and intra-abdominal TB.
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Affiliation(s)
- Richard P T Evans
- Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK
| | - Moustafa Mabrouk Mourad
- Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK
| | - Lee Dvorkin
- North Middlesex University Hospital, London, UK
| | - Simon R Bramhall
- Wye Valley NHS Trust, Department of Surgery, The County Hospital, Union Walk, Hereford, HR1 2ER, UK.
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Wang JP, Zhang MY, Li B, Xia XM. Farnesyl X receptor expression in rat bile duct cancer. Shijie Huaren Xiaohua Zazhi 2015; 23:5201-5206. [DOI: 10.11569/wcjd.v23.i32.5201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop a rat model of bile duct cancer and detect farnesyl X receptor (FXR) expression in bile duct cancer tissues of this model, in order to provide a new method for the prevention and treatment of bile duct cancer.
METHODS: Seventy Wistar rats were randomly divided into either a control group or an experimental group, with 35 rats in each group. The control group was fed an ordinary diet, and the experimental group was fed a 3'-Me-DAB diet. After 20 wk, the bile duct cancer model was successfully established. Bile duct tissues were taken from rats of the control group and bile duct cancer tissues were taken from rats of the experimental group to detect the mRNA expression of FXR by real-time quantitative PCR (qRT-PCR) and protein expression by immunohistochemistry.
RESULTS: qRT-PCR analysis showed that the relative expression level of FXR in the bile duct tissues was significantly higher that in the bile duct cancer tissues. Immunohistochemistry showed that in the experimental group, the positive expression rate of FXR was 21.3%, significantly lower than 72.6% in the control group (χ2 = 10.17, P < 0.05).
CONCLUSION: The expression of FXR decreases significantly in rat bile duct cancer, which suggests that drugs targeting FXR may be a new therapeutic strategy for bile duct cancer.
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Wang JP, Zhang MY, Li B, Xia XM. Ntcp expression in bile duct cancer tissues in rats. Shijie Huaren Xiaohua Zazhi 2015; 23:4694-4699. [DOI: 10.11569/wcjd.v23.i29.4694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To develop a rat model of bile duct cancer and detect sodium/taurocholate cotransporting polypeptide (Ntcp) expression in bile duct cancer tissues of this model, in order to provide a new method for the prevention and treatment of bile duct cancer.
METHODS: Seventy Wistar rats were randomly divided into either a control group or an experimental group, with 35 rats in each group. The control group was fed an ordinary diet, and the experimental group was fed a 3'-Me-DAB diet. After 20 wk, the bile duct cancer model was successfully established. Bile duct tissues were taken from rats of the control group and bile duct cancer tissues were taken from rats of the experimental group to detect the mRNA expression of Ntcp by real-time quantitative PCR (qRT-PCR), and protein expression by immunohistochemistry.
RESULTS: qRT-PCR analysis showed that in the bile duct tissues the Ntcp/GAPDH ratio was 12, but in the bile duct cancer tissues it was 39, which had an obvious difference. Immunohistochemistry showed that in the experimental group, the positive expression rate of Ntcp was 69.2%, significantly higher than 15.3% in the control group (χ2 = 10.28, P < 0.05).
CONCLUSION: The expression of the Ntcp gene increases significantly in rats with bile duct cancer, which suggests that drugs targeting Ntcp may be a new therapeutic strategy for bile duct cancer.
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Hepatic Tuberculosis Mimicking Biliary Cystadenoma: A Radiological Dilemma. Case Rep Surg 2015; 2015:390184. [PMID: 26504607 PMCID: PMC4609399 DOI: 10.1155/2015/390184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/30/2015] [Indexed: 12/18/2022] Open
Abstract
Primary involvement of liver in tuberculosis is a rare entity. It is difficult to diagnose in absence of previous history of tuberculosis or concurrent pulmonary involvement. It is usually misdiagnosed as neoplastic liver lesion, which misdirects the treatment protocol and delays proper treatment. Here we are presenting a case of 36-year-old male patient with vague right upper quadrant abdominal pain. All the laboratory values were within normal limits. Radiological investigations were in favor of biliary cystadenoma but final diagnosis was primary focal involvement of liver in tuberculosis which was histopathologically proven to be tuberculous granulomas on biopsy of the resected mass.
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