Title : Pulmonary tuberculosis presenting as lung mass
Abstract:
INTRODUCTION:
Tuberculosis has a varied presentation and clinically mimics malignancy as both have similar symptoms. Lung masses are usually a benign or malignant lesion, but tuberculosis can also be an uncommon cause of such presentations. Usually the features of active tuberculosis on CT chest includes centrilobular nodules with tree in bud appearance, lobular consolidation, cavitation, bronchial wall thickening, necrotic mediastinal and hilar lymphadenopathy and pleural effusion. Histopathological examination shows epithelioid cell granuloma which constitutes epithelioid histiocytes, peripheral lymphocyte cuffing, langhans giant cells with caseating necrosis.
CASE SERIES:
CASE 1. A 52 year old female was admitted with complaints of breathlessness for 1 year, cough with expectoration for 6 months, reduced appetite and weight loss. She has no comorbidities, no prior tuberculosis history. Chest xray shows homogenous opacity in left upper zone. Sputum CBNAAT – Mtb not detected. CECT chest shows heterogeneously enhancing mass in left upper lobe with mediastinal lymphadenopathy. Fibre optic bronchoscopy shows anthracotic patches, bronchial wash NAAT – Mtb not detected. CT guided biopsy shows areas of caseating necrosis and inflammatory infiltrate composed of lymphocyte, plasma cell, epithelioid cell, langhan type of multinucleated giant cell. Based on the histopathological finding, anti – TB treatment was initiated.
CASE 2. A 53 year old male was admitted with complaints of breathlessness, cough with expectoration for 1 month, with reduced appetite and weight loss. He is a known case of diabetes mellitus on treatment. He was a chronic smoker and had pulmonary tuberculosis 10 years back. CECT chest shows enhancing hyperdense lesion in left hilar region with multiple enlarged enhancing nodes seen at subcarinal and hilar level. Sputum AFB – negative. Fibre optic bronchoscopy shows mass obscuring the left main bronchus, bronchial wash NAAT Mtb not detected. CT guided biopsy shows dense collection of lymphoid aggregates, histiocytes forming granuloma. Based on the histopathological finding, anti – TB treatment was initiated.
DISCUSSION :
WHO estimated 9.6 million new TB cases to have occurred globally, of which 2.2 million is in India alone. There were estimated 1.5 million total TB deaths in 2014 or about 16 death per 1,00,000 population in the world. Tuberculosis of lung can mimic as a mass. Lung malignancy can be solitary pulmonary nodule or mass lesion with ill-defined, spiculated or well defined mass with/without mediastinal lymphadenopathy. Pseudotumoral manifestation occur in 3.5 to 4.5 percent of immunocompetent tuberculosis patients even in endemic areas.
