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Mallik S, Datta A, Sivasankar R, Malik A. Coexistence of Carcinoma and Tuberculosis in the Cecum: A Clinical Conundrum. Cureus 2024; 16:e58675. [PMID: 38774173 PMCID: PMC11107136 DOI: 10.7759/cureus.58675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/24/2024] Open
Abstract
The coexistence of carcinoma of the colon and tuberculosis (TB) represents a rare and intricate clinical scenario. It poses significant challenges in both diagnosis and management. Clinical prediction of this coexistence is challenging since the clinical features of these two conditions are often similar. Likewise, the radiology is not decisive because of the significant overlap in the image findings of carcinoma and TB. A conclusive diagnosis relies on histopathological evidence of both malignancy and TB. Here, we report a case of a 58-year-old female who presented with chronic abdominal pain. Computed tomography showed the presence of a mass in the cecum. Histopathology of tissue retrieved through colonoscopy was indicative of features of both TB and adenocarcinoma of the cecum. Mycobacterium tuberculosis was detected in the tissue by cartridge-based nucleic acid amplification test. The patient was initiated on antitubercular treatment. She underwent surgical resection of the mass and is planned for adjuvant chemotherapy.
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Affiliation(s)
- Sonali Mallik
- Pulmonary Medicine, Institute of Medical Sciences and Sum Hospital, Bhubaneswar, IND
| | - Ananda Datta
- Pulmonary Medicine, All India Institute of Medical Sciences, Deoghar, IND
| | | | - Archana Malik
- Pulmonary Medicine, All India Institute of Medical Sciences, Deoghar, IND
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Adhikari G, Budha B, Shah JK, Ghimire B, Kansakar PBS. Colonic tuberculosis masquerading as ascending colon carcinoma in a patient of FIGO Stage IIB cervical carcinoma following chemo-radiotherapy: A case report. Int J Surg Case Rep 2022; 93:106943. [PMID: 35298988 PMCID: PMC8927692 DOI: 10.1016/j.ijscr.2022.106943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction and importance Case presentation Clinical findings and investigations Interventions and outcomes Relevance and impact The clinical presentation of colonic carcinoma and colonic tuberculosis may be the same preoperatively. Colonic tuberculosis may masquerade as colonic carcinoma, Crohn's disease or ulcerative colitis. Histopathological diagnosis is required to confirm abdominal tuberculosis when in doubt. Response to anti-tubercular drugs verifies the diagnosis of tuberculosis.
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Affiliation(s)
- Gagan Adhikari
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal.
| | - Bishal Budha
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Jayant Kumar Shah
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Bikal Ghimire
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
| | - Prasan B S Kansakar
- Department of General Surgery, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj, Kathmandu, Nepal
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A Retrospective Cohort Study of Coexistence of Carcinoma and Tuberculosis of Colon: 12-Year Experience. Indian J Surg Oncol 2020; 12:61-66. [PMID: 33814833 DOI: 10.1007/s13193-020-01249-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022] Open
Abstract
Coexistence of carcinoma colon and tuberculosis is rare. The aim of this study is to present our 12-year experience on colonic carcinoma with coexisting colonic TB. Histopathology and imaging records of 189 patients of colonic carcinoma patients who underwent treatment in surgical unit 6 in our institute between January 2006 and December 2017 were reviewed. In 7 patients, histopathology and/or imaging studies were suggestive of coexistence of colonic carcinoma and tuberculosis. Fifteen cases of colonic tuberculosis were also reviewed. Descriptive statistics were used to summarize the data. Colonoscopic biopsy was suggestive of only malignant lesion in 6 cases and coexistence of TB and carcinoma in 1 case. The duration of symptoms spanned between 2 and 7 weeks. Anorexia and weight loss were the predominant symptoms. Colonoscopic biopsy was suggestive of only malignant lesion in 6 cases and coexistence of TB and carcinoma in 1 case. The morbidity was low and there was no surgery associated mortality. Clinical awareness and advancement in diagnostic studies and improvement in management strategies may guide and lead to early diagnosis, optimum therapeutic guidelines and thus improved outcome.
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Patel RR, Nandu VV. Primary Appendicular Malignancy Presenting as Abdominal Wall Abscess with Secondary Tuberculosis Infection: an Interesting Case Report. Indian J Surg Oncol 2018; 9:613-617. [PMID: 30538401 DOI: 10.1007/s13193-018-0804-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 07/17/2018] [Indexed: 11/30/2022] Open
Abstract
Cancers of the appendix are rare. Most of them are found accidentally on appendectomies performed for appendicitis. When reviewed, majority of the tumors were carcinoid, adenoma, and lymphoma. Adenocarcinomas of the appendix are only 0.08% of all cancers, and the treatment remains controversial. It can present as appendicitis or lump or abscess. Gastrointestinal tuberculosis most commonly involves the ileocecal region. Disruption of the integrity of mucosal barriers and impairment in cell-mediated immunity associated with cancerous growth are known to predispose to bacterial infection. The role of antituberculosis therapy and chemotherapy is unclear due to lacking randomized trials but seems to be accepted if there is lymph node involvement or peritoneal seeding. Here, we are reporting a 69-year-old lady presented with symptoms of abdominal wall abscess with tuberculosis infection which was then diagnosed with mucinous adenocarcinoma of the appendix. The patient was treated with incision and drainage followed by the right hemicolectomy. Up to date, she remains asymptomatic and continuing with chemotherapy.
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Affiliation(s)
| | - Vipul Versi Nandu
- Parvarish Nursing Home, Andheri, Mumbai, Maharashtra India.,2Department of General Surgery, Dr. R.N. Cooper Hospital, Maharashtra, Mumbai, India
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Lin HH, Jiang JK, Lin JK. Collision tumor of low-grade B-cell lymphoma and adenocarcinoma with tuberculosis in the colon: a case report and literature review. World J Surg Oncol 2014; 12:147. [PMID: 24885098 PMCID: PMC4020310 DOI: 10.1186/1477-7819-12-147] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 04/29/2014] [Indexed: 12/25/2022] Open
Abstract
This report presents a case of collision tumors of low-grade B-cell lymphoma and adenocarcinoma in the sigmoid colon of an 81-year-old man. All surgically resected regional mesenteric lymph nodes were found to be occupied by low-grade B-cell lymphoma, and one lymph node showed the presence of adenocarcinoma. Low-grade B-cell lymphoma was also observed in the resected spleen. Moreover, concurrent tuberculosis infection in the resected colon was proven by the presence of positive results obtained with polymerase chain reaction analysis of the mycobacterial DNA. Systemic chemotherapy was administered for advanced colon cancer with lung metastasis, and anti-tuberculosis treatment was also prescribed. The occurrence of synchronous lymphoma and adenocarcinoma of the colorectal region is rare. Furthermore, collisions of these different entities are also extremely unusual. The accurate clinical determination of the dominant tumor and a timely follow-up are required for the proper treatment of these cases.
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Affiliation(s)
| | | | - Jen-Kou Lin
- Division of Colon & Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, No 201, Sec, 2, Shih-Pai Road, Taipei 11217, Taiwan.
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Abstract
Isolated colonic tuberculosis (TB) is rare, and the symptoms are nonspecific making early diagnosis and management difficult. Although colonoscopy and biopsy is an important diagnostic modality, the features are variable and the distinction from other conditions of the colon, especially Crohn’s disease and cancer, may be impossible without surgical resection. We report a case of ascending colon TB which was mistaken for colonic cancer during colonoscopy, with non-specific results on biopsy. The diagnosis was finally made when the histopathology report was received. The diagnostic dilemma of colonic TB is discussed.
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Affiliation(s)
- A Kumar
- Rajindra Hospital, Patiala, Punjab, India
| | - M Patodia
- Rajindra Hospital, Patiala, Punjab, India
| | - Pk Pandove
- Rajindra Hospital, Patiala, Punjab, India
| | - Vk Sharda
- Rajindra Hospital, Patiala, Punjab, India
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Chakravartty S, Chattopadhyay G, Ray D, Choudhury CR, Mandal S. Concomitant tuberculosis and carcinoma colon: coincidence or causal nexus? Saudi J Gastroenterol 2010; 16:292-4. [PMID: 20871197 PMCID: PMC2995101 DOI: 10.4103/1319-3767.70619] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Two rare cases of adenocarcinoma of the caecum and ascending colon concomitant with tuberculosis at the same site are reported. The plausibility of an aetiological relationship between the two pathological conditions has been discussed along with a review of the relevant literature. Tuberculosis complicating malignant disease is a diagnostic and therapeutic challenge; and the likelihood of the two occurring together should be kept in mind especially in tuberculosis endemic areas and in patients with equivocal symptoms.
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Affiliation(s)
| | | | - Dipankar Ray
- Department of Surgical Gastroenterology, Medical College, Kolkata, India
| | | | - Subhayan Mandal
- Department of Surgical Gastroenterology, Medical College, Kolkata, India
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Desai S, Jagtap S, Janugade H. Coexisting Tuberculosis And Mucinous Carcinoma Of Caecum - A Case Report. Med J Armed Forces India 2005; 61:197-9. [PMID: 27407752 DOI: 10.1016/s0377-1237(05)80028-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2002] [Accepted: 08/26/2004] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Sunil Jagtap
- Lecturer, Department of Pathology, KIMS, Karad 415 110
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Namisaki T, Yoshiji H, Fujimoto M, Kojima H, Yanase K, Kitade M, Ikenaka Y, Toyohara M, Yamao J, Tsujimoto T, Tsuruzono T, Kitano H, Matsumura K, Matsumura Y, Fukui H. Two cases of colonic tuberculosis presenting with massive melena. Int J Clin Pract 2004; 58:1162-4. [PMID: 15646415 DOI: 10.1111/j.1742-1241.2004.00361.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The clinical symptoms of colonic tuberculosis are variable, among which massive melena is extremely rare. Herein, we report two cases of colonic tuberculosis representing with massive melena, both of whom never had active pulmonary tuberculosis. The first case was a 55-year-old woman. Although her emergency colonoscopic setting suggested colonic tuberculosis, no evidence of tuberculosis could be found at that time. We performed a therapeutic trial and observed a drastic regression of the initial changes with 4-week treatment using antituberculous agents. The second case was a 37-year-old man. His emergency colonoscopy showed lesions mimicking colon carcinoma. However, the histological examinations did not indicate malignancy. The polymerase chain reaction of colonic biopsy specimen was positive for Mycobacterium tuberculosis. Similar to the first case, a significant improvement of the initial lesions was observed after 4-week treatment using antituberculous agents. Collectively, although the massive melena is a rare manifestation, tuberculosis of the colon should be suspected in the patients with such symptom.
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Affiliation(s)
- T Namisaki
- Third Department of Internal Medicine, Nara Medical University, Nara, Japan
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Kaw LL, Punzalan CK, Crisostomo AC, Bowyer MW, Wherry DC. Surgical pathology of colorectal cancer in Filipinos: implications for clinical practice. J Am Coll Surg 2002; 195:188-95. [PMID: 12168965 DOI: 10.1016/s1072-7515(02)01186-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND A number of studies published in the Philippine literature have demonstrated certain peculiar clinicopathologic characteristics of colorectal cancer among Filipinos. This study presents the latest data and analyzes their implications for clinical practice. STUDY DESIGN The pathology reports of all patients who underwent operation for colorectal cancer at the Philippine General Hospital over a period of 7 years were reviewed. RESULTS One thousand two hundred seventy-seven patients were included. The male to female ratio was almost 1:1. The majority of patients were in the sixth and seventh decades of life, with a mean age of 55.3 years. Patients 40 years of age and younger made up 17% of the total. The site of cancer in order of frequency was rectum (49.8%), left colon (27.9%), and right colon (21.4%). Cancers of the right colon were more common in women, and rectal cancers were more frequent in men. Seventy-six percent of the tumors were well to moderately differentiated adenocarcinomas, and 6.7% were poorly differentiated. Mucinous and signet ring carcinomas were found in 11% and 1% of cases, respectively. Forty-four percent of patients had localized disease at the time of operation, 54% had regional disease, and 2% had disseminated disease. Associated predisposing conditions noted were polyps (4.7%), schistosomiasis (3%), and tuberculosis (1.5%). CONCLUSIONS Colorectal cancer in Filipinos exhibits a number of unique clinicopathologic features, such as a higher proportion of early age of onset tumors, more advanced stage at presentation, an association with chronic granulomatous diseases, and relatively rare occurrence with polyps. This might suggest the possibility of a different pathway for tumor development of colorectal cancer in this population of patients. Also, current screening guidelines advocated for the Western population might not be appropriate for Filipinos.
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Affiliation(s)
- Leoncio L Kaw
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Chung CK, Meng WC, Thomas TM, Chan MC, Lau Y, Yip AW. Rectal stricture due to tuberculosis. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1999; 69:828-9. [PMID: 10553977 DOI: 10.1046/j.1440-1622.1999.01707.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C K Chung
- Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong
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12
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Wainwright M. When heresies collide--extreme bacterial pleomorphism and the cancer germ. MICROBIOLOGY (READING, ENGLAND) 1998; 144:595-596. [PMID: 9696620 DOI: 10.1099/00221287-144-3-595] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Puri AS, Vij JC, Chaudhary A, Kumar N, Sachdev A, Malhotra V, Malik VK, Broor SL. Diagnosis and outcome of isolated rectal tuberculosis. Dis Colon Rectum 1996; 39:1126-9. [PMID: 8831528 DOI: 10.1007/bf02081413] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Segmental colonic tuberculosis commonly involves the ascending, transverse, or sigmoid colon. Rectal involvement in tuberculosis is uncommon and poorly characterized. This study describes the clinical presentation, endoscopic features, and outcome of isolated rectal tuberculosis. METHODS Isolated rectal tuberculosis was defined as focal lesions of the rectum in the absence of radiologically demonstrable lesions in the small and large bowel on barium contrast studies. Diagnosis of rectal tuberculosis was based on characteristic endoscopic appearance of lesions, histopathologic features of tuberculosis in biopsy/ resected material, and response to antitubercular therapy. RESULTS Eight patients with rectal tuberculosis were seen during a four-year period at our hospital. Hematochezia was the most common presenting feature (88 percent), followed by constitutional symptoms (75 percent) and constipation (37 percent). Rectal examination revealed a tight stricture within 10 cm of the anal verge in seven patients. Barium enema showed stricture of variable length, with focal areas of deep mucosal ulceration and increase in presacral space. Proctoscopic findings were tight stricture (7), nodularity with ulceration (6), and multiple aphthous ulcers (1). Granulomatous infiltration was detected in seven of eight patients in biopsy material obtained at endoscopy (6) or surgery (1). Cessation of hematochezia, resolution of constitutional symptoms, and weight gain were seen in all patients following treatment with antitubercular drugs. CONCLUSION Our data suggest that tubercular involvement of rectum, although uncommon, is an important cause of rectal strictures in India. Response to antitubercular chemotherapy is uniformly good, and surgery is seldom required in these patients.
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Affiliation(s)
- A S Puri
- Department of Gastroenterology, G. B. Pant Hospital, New Delhi, India
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