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Chen CY, Wang JY, Chien YC, Chen KY, Yu CJ, Yang PC. Lung cancer mimicking pulmonary tuberculosis in a TB-endemic country: the role of early invasive diagnostic procedures. Lung Cancer Manag 2015. [DOI: 10.2217/lmt.14.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Aim: This study aimed to investigate the impact of early invasive diagnostic procedures on detecting lung cancers that mimic pulmonary TB. Patients & methods: Patients with an initial diagnosis of pulmonary TB, which was later revised to lung cancer, were included. Patients were classified into early and late intervention groups. Clinical characteristics, chest radiographic images, diagnostic procedures and outcomes were analyzed. Results: There were 53 patients with a revised diagnosis of lung cancer included. The time between diagnoses of TB and cancer for the early and late intervention group was 1.1 ± 1.1 and 5.5 ± 10.2 months, respectively (p = 0.01). For patients with advanced stage lung cancer, those received early interventions survived longer than those that did not receive early interventions (10.3 vs 3.3 months; p = 0.89). Conclusion: In a TB-endemic area, invasive diagnostic procedures may be helpful to avoid a misdiagnosis in patients with lung cancer mimicking pulmonary TB.
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Affiliation(s)
- Chung-Yu Chen
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital & College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin County, Taiwan
| | - Jann-Yuan Wang
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital & College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Chun Chien
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital & College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuan-Yu Chen
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital & College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chong-Jen Yu
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital & College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pan-Chyr Yang
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital & College of Medicine, National Taiwan University, Taipei, Taiwan
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Wu CY, Hu HY, Pu CY, Huang N, Shen HC, Li CP, Chou YJ. Pulmonary tuberculosis increases the risk of lung cancer: a population-based cohort study. Cancer 2010; 117:618-24. [PMID: 20886634 DOI: 10.1002/cncr.25616] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 07/24/2010] [Accepted: 08/03/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND The possible effect of pulmonary tuberculosis (TB) on subsequent lung cancer development has been suspected, but the evidence remains inconsistent. The purpose of this study was to perform a nationwide population-based cohort study to investigate the risk of lung cancer after pulmonary TB infection. METHODS This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database. In total, 5657 TB patients and 23,984 controls matched for age and sex were recruited for the study from 1997 to 2008. RESULTS The incidence rate of lung cancer (269 of 100,000 person-years) was significantly higher in the pulmonary TB patients than that in controls (153 of 100,000 person-years) (incidence rate ratio [IRR], 1.76; 95% confidence interval [CI], 1.33-2.32; P < .001). Compared with the controls, the IRRs of lung cancer in the TB cohort were 1.98 at 2 to 4 years, 1.42 at 5 to 7 years, and 1.59 at 8 to 12 years after TB infections. The multivariate Cox proportional hazards model revealed pulmonary TB infections (hazard ratio [HR], 1.64; 95% CI, 1.24-2.15; P < .001) and chronic obstructive pulmonary disease (HR, 1.09; 95% CI, 1.03-1.14; P = .002) to be independent risk factors for lung cancer. CONCLUSIONS Pulmonary infection with TB is associated with an increased risk of lung cancer.
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Affiliation(s)
- Chen-Yi Wu
- Division of Dermatology, Taipei County Hospital, Taipei County, Taiwan
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Dalal PU. Non-metastatic manifestations of cancer in the chest. IMAGING 2008. [DOI: 10.1259/imaging/83642253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Sasaki H, Naka N, Kitahara N, Yoshikawa S, Goto M, Tamura M, Tanaka H, Okumura M, Matsumura A, Luchi K. Right Partial Anomalous Pulmonary Venous Connection Found During Lobectomy for Coexisting Lung Cancer and Tuberculosis: Report of a Case. Clin Lung Cancer 2006; 7:350-2. [PMID: 16640808 DOI: 10.3816/clc.2006.n.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Herein, we report a rare case of a 59-year-old man in whom a partial anomalous pulmonary venous connection was found during an operation for coexisting lung cancer and tuberculosis. It was observed that the anomalous vein drained only from the right upper lobe into the right superior vena cava. The middle and lower pulmonary veins connected normally, and there was no atrial septal defect or any other anomalous condition. An upper lobectomy for coexisting lung cancer and tuberculosis with ligation of the partial anomalous pulmonary venous connection was successfully performed.
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Affiliation(s)
- Hidefumi Sasaki
- Department of Surgery, National Kinki Central Hospital, Sakai, Osaka, Japan.
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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 J Radiol 2001; 2:138-44. [PMID: 11752984 PMCID: PMC2718111 DOI: 10.3348/kjr.2001.2.3.138] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Bronchogenic 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 METHODS The 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. RESULTS Lung 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). CONCLUSION Most 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.
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Affiliation(s)
- Young Il Kim
- Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC, Korea
| | - Hyae Young Kim
- Department of Radiology, Ilsan National Cancer Center, Korea
| | - Jae Woo Song
- Department of Radiology, Seoul Municipal Boramae Hospital, Korea
| | - Jung-Gi Im
- Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC, Korea
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Tamura A, Hebisawa A, Hayashi K, Sagara Y, Kawabe Y, Nagayama N, Machida K, Fukushima K, Yotsumoto H, Mori M. Lung cancer in patients who had received thoracoplasty for pulmonary tuberculosis. Jpn J Clin Oncol 1999; 29:541-5. [PMID: 10678556 DOI: 10.1093/jjco/29.11.541] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Japan in the 1950s, thoracoplasty was a powerful therapy for pulmonary tuberculosis. Now there are many aged people who have tuberculosis sequelae caused by thoracoplasty. We have encountered some cases of lung cancer among these people. METHODS To elucidate the features of lung cancer occurring after thoracoplasty for pulmonary tuberculosis, we reviewed for analysis 20 such cases. RESULTS There were 17 men and three women, aged 55 to 78 years (mean 65 years). All had respiratory dysfunction and most were cigarette smokers. Lung cancers were located in the upper lobes in nine cases, in the middle lobe in one and in the lower lobes in 10. Ten lung cancers were in the thoracoplastied lung and the remaining 10 in the opposite lung. Histologically, squamous cell carcinoma was predominant (11 cases). Eight lung cancers were detected in stages I and II and 12 in stages III and IV. Most cancer lesions were separate from tuberculosis lesions. Surgical resection was selected in only three of 11 stages I-IIIA cases in consideration of respiratory dysfunction and/or ventilatory impairment due to thoracoplasty. Chemotherapy and/or radiotherapy were performed in nine and supportive care alone was performed in eight. Fourteen patients died of lung cancer and four died of cor pulmonale due to tuberculosis sequelae. Five-year survival was achieved in only one surgical case. Eight of the nine patients who received chemotherapy or radiotherapy died within 1 year, and, further, seven of eight patients who received supportive care died within 6 months. CONCLUSION Lung cancer in the patients who had received thoracoplasty occurred in each lung and every lobe, independent of thoracoplasty. In addition, delay of detection was such that stage III-IV cases were in the majority, there were some limitations in therapeutic benefits related to thoracoplasty and the prognosis was very poor. Physicians should avoid delay in the detection of lung cancer through careful follow-up of such patients.
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Affiliation(s)
- A Tamura
- Department of Respiratory Diseases, Tokyo National Chest Hospital, Kiyose, Japan
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Bergen GA, Shelhamer JH. Pulmonary infiltrates in the cancer patient. New approaches to an old problem. Infect Dis Clin North Am 1996; 10:297-325. [PMID: 8803622 DOI: 10.1016/s0891-5520(05)70300-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A variety of etiologies may produce pulmonary infiltrates in a patient with cancer. Infectious etiologies, of an ever-increasing number, are always of paramount concern due to their high mortality in this patient population. Patients may be rendered immunosuppressed for prolonged periods of time and therefore are highly susceptible to infection. We present an overview of the many causes of pulmonary infiltrates in the cancer patient and an approach to diagnosis and treatment.
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Affiliation(s)
- G A Bergen
- Division of Infections, Diseases and Tropical Medicine, University of South Florida College of Medicine, Tampa, USA
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Abter EIM, Schaening O, Barbour RL, Lutwick LI. Tuberculosis in the adult. Tuberculosis (Edinb) 1995. [DOI: 10.1007/978-1-4899-2869-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Martínez Moragón E, Cordero Rodríguez P, Sanchís Aldás J, León Fábregas M, Perpiñá Tordera M, Aparicio Urtasun J. Coexistencia de carcinoma broncogénico y tuberculosis pulmonar activa. Arch Bronconeumol 1995. [DOI: 10.1016/s0300-2896(15)30985-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Approach to the Patient with Lung Cancer. Lung Cancer 1985. [DOI: 10.1007/978-3-642-82234-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Keagy BA, Starek PJ, Murray GF, Battaglini JW, Lores ME, Wilcox BR. Major pulmonary resection for suspected but unconfirmed malignancy. Ann Thorac Surg 1984; 38:314-6. [PMID: 6486947 DOI: 10.1016/s0003-4975(10)62278-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Thoracotomy is not infrequently performed in patients with suspected pulmonary carcinoma but with no histological or cytological confirmation of malignancy. The intraoperative decision to proceed with major pulmonary resection (lobectomy or pneumonectomy) is difficult if a large or central lesion precludes total excisional biopsy. Incisional or needle biopsies violate the principles of good cancer surgery, and the results may be inconclusive if the tumor is missed and areas of associated inflammation or necrosis are sampled. Between January 1, 1970, and December 31, 1980, 303 patients underwent thoracotomy for suspected but unconfirmed malignancy. One hundred twenty-two had a minor resection only, 79 had a major resection (lobectomy or pneumonectomy) after a diagnosis was established by frozen section, and 102 had a major resection without a definitive diagnosis of cancer. Carcinoma subsequently was found in 68% (69) of this group of 102 patients, and benign lesions were identified in the remaining 32% (33), all of whom underwent lobectomy. The diagnoses in these 33 patients included seven granulomas, three hamartomas, nine instances of tuberculosis, and fourteen instances of fibrosis, inflammation, or cystic degeneration. The 2 thirty-day operative deaths in this group of 102 patients occurred among the 69 with malignant disease; 1 died of hemorrhage following pneumonectomy and 1, of respiratory insufficiency after lobectomy. In all 303 patients, there was no difference in operative mortality (p less than 0.01) between lobectomy (2%) and a lesser resection (1.6%). In a patient with a suspicious but inaccessible pulmonary lesion, lobectomy can be performed safely without violating the principles of cancer surgery. This recommendation should probably not be extended to lesions requiring pneumonectomy, because of the increased rates of morbidity and mortality associated with that procedure.
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Nandi PL, Tang SC, Mok CK, Lee WT, Ong GB. Pulmonary coin lesions: a ten-year review of 239 cases. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1981; 51:56-8. [PMID: 6939424 DOI: 10.1111/j.1445-2197.1981.tb05906.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The results of a study of 239 resected solitary pulmonary nodules are presented; 66.5% of the resected nodules were malignant, and there were three patients with malignant coin lesions who were under 30 years of age. These findings confirm the generally accepted fact that most solitary pulmonary nodules must be resected if the presence of cancer is to be excluded. Transbronchial biopsy under biplane fluoroscopic guidance through a flexible bronchoscope may provide an effective alternative to early thoracotomy in the future, so that malignant nodules can be diagnosed before operation and patients with benign lesions are spared a thoracotomy.
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