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Lung Cancer |

Two Pathologies Influencing Each Other - Lung Cancer and Pulmonary Tuberculosis. Clinical Case Presentation

Oana Deleanu, MD; Andra Malaut, MD; Ana Nebunoiu, MD; Ruxandra Ulmeanu, PhD; Ileana Rohan, MD; Florin Mihaltan*, PhD
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University of Medicine and Pharmacy Carol Davila, Bucharest, Romania


Chest. 2012;142(4_MeetingAbstracts):613A. doi:10.1378/chest.1389972
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Abstract

SESSION TYPE: Cancer Global Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Association of pulmonary tuberculosis (TB) and lung cancer is controversial but not unusual, often neoplastic cells are localized on TB sequelae[1]. Studies have shown that incidence of lung cancer is 11 times greater in patients with TB[2].

CASE PRESENTATION: Male patient, 55 years old, former heavy smoker, with history of: chronic alcoholism, treated pulmonary TB (2007), pharyngeal carcinoma (chemotherapy, radiotherapy 2006), Paget’s disease. Sputum examination confirmed radiological findings: secondary infiltrative nodular pulmonary TB. After 2 weeks of treatment patient accused polyuria, associating intense confusional state and abnormal gait. Neurological consult associated with a cerebral computer-tomography (CT) ruled out the suspicion of neurological disorder. Laboratory: hypercalcemia with normal parathormone; diagnosis was paraneoplastic secondary hyperparathyroidism with unspecified starting point. After cardiopulmonary arrest the patient survived 6 weeks mechanically ventilated. Technical conditions did not allowed performing thoracic CT, the bronchoscopy did not showed endobronchial lesions, but the necropsy confirmed the suspicion of lung cancer - epidermoid carcinoma.

DISCUSSION: Special attention must be drawn to the etiology of the hypercalcemia, as the cause may be the patient’s previously known Paget’s disease. Primary or secondary hyperparathyroidism (as paraneoplastic phenomenon) may be other causes of hypercalcemia. Studies have shown that responsible for paraneoplastic hypercalcemia are: head and neck, esophagus, lung, breast or renal carcinoma[3]. Also there must be established what determined the immunosuppresion causing pulmonary TB recurrence. Evidence suggests that the inflammatory processes and remodeling after pulmonary TB may play central role in carcinogenesis in patients associating both diseases. The reverse causality must also be considered as tuberculosis may have been the result of weakened immune system due to the lung cancer. In this case it is difficult to conclude whether TB sequelae caused lung cancer or the lung cancer simply associated in a patient with previously known pulmonary TB.

CONCLUSIONS: Patients with pulmonary tuberculosis must be closely followed with thorough clinical examination and extensive paraclinical investigations to detect any existing or subsequently lung cancer that may mimic TB.

1) Lung cancer in patients with tuberculosis. Saulius Cicenas, Vladislavas Vencevičius. World Journal of Surgical Oncology 2007, 5:22. 19 February 2007

2) Increased lung cancer risk among patients with pulmonary tuberculosis: a population cohort study, Yu YH, Liao CC, Hsu WH, Chen HJ, Liao WC, Muo CH, Sung FC, Chen CY, J Thorac Oncol., 2011 Jan; 6(1): 32-7.

3) Andrew F. Stewart, Hypercalcemia Associated with Cancer, N Engl J Med 2005;352:373-9

DISCLOSURE: The following authors have nothing to disclose: Oana Deleanu, Andra Malaut, Ana Nebunoiu, Ruxandra Ulmeanu, Ileana Rohan, Florin Mihaltan

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University of Medicine and Pharmacy Carol Davila, Bucharest, Romania

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