Gastric cancer and concomitant gastric tuberculosis: a case report

Coexistence of malignancy and tuberculosis: is it double disease or double hit related to COVID-19? - Experience from a tertiary care center

BACKGROUND

Coexistent malignancy and tuberculosis (TB) are rarely encountered. Cancer patients are a highly vulnerable subgroup during this Covid crisis. Delayed treatment for malignancy because of COVID-19 pandemic leads to higher chances to get infections.

PURPOSE

The present study aimed to present the clinicopathologic profile of the patients with coexistent carcinoma and TB during the COVID-19 pandemic in a tertiary care center.

MATERIALS AND METHODS

This was a retrospective study conducted during the COVID-19 pandemic between April 2020 to May 2021 in the Department of Pathology of our Institute. 11 patients with coexistent malignancy and caseous necrotizing granulomatous inflammation with Langhans giant cells and or acid-fast bacilli (AFB) positivity were included in the study. Cases of ill-defined granulomas coexistent malignancy were excluded. We studied varied clinical and histopathologic features of these cases.

RESULTS

Eleven cases were reported with coexistent malignancy and tuberculosis, of which 8 were reported in 2021 and 3 cases were reported in 2020. Adenocarcinoma comprised 9 cases (81.8%) and the remaining 2 were squamous cell carcinoma (18.1%). Out of 11, 10 (90.9%) were new TB cases. Of these, 10 were extrapulmonary TB and one pulmonary TB case with cancer. Regarding chemotherapy, four patients accepted that chemotherapy was delayed because of the COVID-19 crisis.

CONCLUSION

In this covid pandemic, India being the 2^nd most populous country and endemic for TB, there is a higher chance of latent and active TB. The coexistence of two different pathologies is rare, even in a region with a high incidence of TB. Delayed chemotherapy in a pandemic situation leads to an increased incidence of infectious diseases such as TB.

Primary isolated asymptomatic gastric tuberculosis of the cardia mimicking gastric stromal tumor: a rare case report and literature review

Background

Primary isolated gastric TB of the cardia presenting as a submucosal tumor is extremely rare.

Case presentation

A 60-year-old female was admitted to our department; endoscopy revealed a smooth protruding lesion in the gastric cardia. The patient was diagnosed with a gastric cardia stromal tumor and the lesion was seen in muscularis propria by endoscopic ultrasonography (EUS). Endoscopic submucosal dissection (ESD) revealed that the lesion was filled with a milky, white liquid and white granulation tissue. Acid-fast specimen staining was negative. Hematoxylin and eosin staining showed patches of caseating necrosis and granulomatous inflammation. Gene sequencing subsequent to polymerase chain reaction (PCR) analysis of the ESD specimen identified Mycobacterium tuberculosis (M. TB) DNA fragments. The patient was put on ATT for 6 months.

Conclusion

Primary isolated gastric TB of the cardia should be suspected in patients without clinical symptoms whose manifestations are similar to those associated with submucosal tumors. TB-PCR may be helpful for further diagnosis.

Critical role of molecular test in early diagnosis of gastric tuberculosis: a rare case report and review of literature

Backgroud

Early diagnosis of gastric tuberculosis is often challenging because the disease is very rare and its clinical manifestation is nonspecific and misleading. To raise the awareness and emphasize early diagnosis of gastric tuberculosis, we present a case of gastric tuberculosis secondary to pleural and pulmonary tuberculosis.

Case presentation

A 26-year-old woman complained gastric pain for 1 month but showed no other symptoms, who had no previous exposure to tuberculosis.Gastric stromal tumor was originally suspected. However, the pathology of her gastroscopic biopsy of the gastric lesion showed granulomatous lesions and caseating necrosis. Gene sequencing of the biopsy specimen identified deoxyribonucleic acid fragment of Mycobacterium tuberculosis. Chest computed tomography scan revealed nodular shadows in the lesser curvature soft tissue of the stomach, patchy densities and calcified nodular shadows in the upper right lung, bilateral pleural thickening, and calcified pleural nodules. Thus, the diagnosis was gastric tuberculosis secondary to pulmonary and pleural tuberculosis. The patient was hospitalized and treated with the antituberculosis therapy for 1 week. After discharged from the hospital, the patient continued routine antituberculosis therapy for 18 months and was follow-up was normal.Literature search found 22 cases of gastric tuberculosis reported from 2000 to 2016. Review of the 22 cases suggested that polymerase chain reaction has been increasingly used in the recent years in addition to the conventional histopathological and bacteriological approaches.

Conclusion

Clinical presentation of gastric tuberculosis is not specific.When granuloma or caseation is detected on biopsy in patients who are suspected of having gastric malignancy or acid peptic diseases, polymerase chain reaction for Mycobacterium tuberculosis could be used as an available and sensitive diagnostic test in addition to pathology, acid-fast bacilli smear staining and culture.

Gastric tuberculosis

Tuberculosis of the stomach is an extremely rare manifestation of Mycobacterium tuberculosis infection and mimics gastric carcinoma in its presentation. Most of our knowledge about this rare disease comes from case reports and there are only a few case series published on this disease and thus the majority of the part remains uncovered. Diagnosis is made commonly only after a major surgery. Endoscopy and guided biopsy are the diagnostic modality of choice. Surgery is indicated in cases which present with complications. Patients respond well to antituberculous therapy. The authors encountered 4 cases of gastric tuberculosis over 5 years. This study summarises the available literature and gives comprehensive update on this rare disease.

Gastrointestinal Tuberculosis

Gastrointestinal tuberculosis (TB) is a fascinating disease which can be observed both in the clinical context of active pulmonary disease and as a primary infection with no pulmonary involvement. It represents a significant clinical challenge because of the resurgence of TB as well as the diagnostic challenges it poses. A high clinical suspicion remains the most powerful tool in an era of medicine when reliance on diagnostic technology increases. Antimicrobial therapy is the mainstay of therapy, but surgical and endoscopic interventions are frequently required for intestinal TB. Gastrointestinal TB is truly the "great mimic" and continues to require the astute clinical acumen of skillful clinicians to diagnose and treat.

Coexistence of tuberculosis and malignancy: a mere coincidence or a causal association

Tuberculosis (TB) and malignancy are among the most important current global health problems. Many authors suggest that their coexistence is a chance association owing to their high prevalence. There is, however, enough evidence that one condition may predispose the other. In our retrospective report of two cases, TB in draining lymph nodes was discovered incidentally on histopathology, following surgical resection for malignancy. The possibility of coexistent lesions, especially in regions endemic for TB, mandate a detailed histopathological examination to prevent the chances of diagnostic failure and thus therapeutic error.