SESSION TITLE: Cancer Global Case Reports
SESSION TYPE: Global Case Report
PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM
INTRODUCTION: Lung cancer and pulmonary TB can mimic each other, and accurate diagnosis is delayed in most cases where both diseases are present. The frequency of coexistence of lung cancer and pulmonary TB has been estimated to be 1-5%. Prior to this report, no known cases of primary pulmonary spindle cell sarcoma with concomitant pulmonary TB had been reported. We report a case of primary spindle cell sarcoma with concomitant pulmonary TB in the same lung.
CASE PRESENTATION: A 67-year-old woman was admitted to hospital with complaints of dyspnea and cough. She was a chronic smoker. The physical examination was remarkable except for decreased breathing sounds in the left lung field. A 10 x 8 cm left thigh mass without pain or tenderness was observed. This mass had appeared 50 years earlier and at that time was diagnosed as a benign tumor. A chest x-ray showed a large amount of left pleural effusion. Thoracentesis with drainage tube insertion was performed. The pleural fluid was bloody and the analysis revealed lymphodominant exudate. CT of the thorax revealed a sub-pleural mass in the left upper lobe, and several non-calcified nodules in the right lung. Percutaneous needle biopsy was performed and the results showed chronic granulomatous inflammation with necrosis. A sputum AFB stain revealed one positive finding, and was cultured to reveal M.tuberculosis. She was discharged after starting anti-TB medications on the 15th hospital day. 1 month after discharge, she was again admitted due to chest discomfort. Follow-up chest CT showed a growing lung mass despite continued anti-TB treatment. So, we considered a variety of causes. Through history taking and drug resistance tests, we were able to rule out progression of pulmonary TB and considered the possibility of combined disease. We also noted a lump on left chest wall. On chest CT, the mass was identified as an implantation metastasis because it was protruding from the pleural. Ultrasonography-guided biopsy of the mass was performed and diagnosed as a spindle cell sarcoma. Because primary pulmonary sarcoma is uncommon, a left thigh mass biopsy was done. The biopsy revealed spindle cells without evidence of malignancy. Despite all of the additional examinations, we could not find another site of spindle cell sarcoma. Surgical resection and chemotherapy were considered, but as the patient was inoperable and showed a poor ECOG score, palliative care was provided. The patient died 2 months after the onset of symptoms.
DISCUSSION: Case reports of coexisting lung cancer and pulmonary TB have occasionally been documented. Although all histological types of lung cancer can coexist with pulmonary TB, there has been no prior case report of the simultaneous occurrence of primary spindle cell sarcoma and pulmonary TB. This is probably because primary spindle cell sarcoma is a rare malignancy. TB and malignancy are able to mimic each other and the diagnosis is delayed in most cases with concomitant disease. In our case, both diseases were located in the same lung and the diagnosis was delayed because pulmonary TB was masking the primary spindle cell sarcoma. When two different diseases are located in the same lesion, the diagnosis can be difficult. Even after a patient has been diagnosed with a disease, clinicians should not rule out the possibility of other diseases and must be aware that two different pathological processes may coexist in the same patient.
CONCLUSIONS: We report a case of coexisting primary spindle cell sarcoma and pulmonary TB in a 67-year-old woman who presented with dyspnea and cough. To the best of our knowledge, this is the first case report of such coexistence.
Reference #1: Sakuraba M, Hirama M, Hebisawa A, Sagara Y, Tamura A, Komatsu H. Coexistent lung carcinoma and active pulmonary tuberculosis in the same lobe. Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia 2006;12(1):53-55.
Reference #2: Kim YI, Goo JM, Kim HY, Song JW, Im JG. Coexisting bronchogenic carcinoma and pulmonary tuberculosis in the same lobe: radiologic findings and clinical significance. Korean journal of radiology : official journal of the Korean Radiological Society 2001;2(3):138-144.
Reference #3: Ashizawa K, Matsuyama N, Okimoto T, Hayashi H, Takahashi T, Oka T, et al. Coexistence of lung cancer and tuberculoma in the same lesion: demonstration by high resolution and contrast-enhanced dynamic CT. The British journal of radiology 2004;77(923):959-962.
DISCLOSURE: The following authors have nothing to disclose: Hong Mo Kang, Jee-Hong Yoo, Myung Jae Park, Cheon Woong Choi, Bok Soon Chang, So Hee Park, Young-Hak Cho
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