Document Type: Letters to the Editor

Authors

1 Dept. of Pathology, Malda Medical College, Malda, West Bengal, India

2 Dept. of Pathology, Burdwan Medical College, West Bengal, India

3 Dept of Pathology, Calcutta National Medical College, Kolkata, India

Dear Editor-in-Chief

More than 30% of the global population is affected by tuberculosis (TB) and most of them live in the Southeast Asia and Sub-Saharan Africa (1). Tuberculosis, particularly in the extra pulmonary form is notorious for mimicking neoplastic lesions, very frequently, malignant tumors.

This study depicts seven cases of extra pulmonary lesions mimicking malignancy, diagnosed by FNAC. One of them was a USG guided FNAC of mesenteric lymph node. Other lesions presented as soft tissue swelling around wrist joint, painful gluteal mass, non-healing ulcer over chest wall, painless swelling over back and a painful swelling on the right lateral aspect of tongue respectively. The smears were stained by MGG, H&E and ZN stains.

A very brief account of the cases is depicted below by means of Table 1.

 

Table 1- A brief account of cases

Case no.

Age

Sex

Site

Clinical findings

Clinical suspicion

FNAC findings

(Aspirate; Microscopy; ZN stain)

Diagnosis

1

61

M

Left wrist joint

Painless soft tissue swelling around; no complain of cough or fever; X-ray: soft tissue swelling.

Bone tumor/ soft tissue neoplasm

Blood mixed aspirate; Epithelioid cell granuloma, Langhans giant cell and caseous necrosis; AFB +ve

Tubercular lesion

2

26

M

Gluteal region

Painful large lump with surface ulcerations for 6 months

Soft tissue malignancy

Blood mixed aspirate; Tubercular granuloma seen on microscopy; AFB +ve

Tubercular lesion

3

59

M

Chest wall

Non-healing ulcer for 8 months

Squamous cell carcinoma

Blood mixed aspirate; Tubercular granuloma seen on microscopy; AFB +ve

Tubercular lesion

4

65

M

Right lateral margin of tongue

Painful reddish lesion at the right lateral margin of tongue for 1 month.Inflamed induration present

Neoplastic lesion

Blood mixed aspirate; Tubercular granuloma seen on microscopy; AFB +ve

Tubercular lesion

5

35

M

Preaortic, paraaortic and mesenteric lymphadenopathy

Pain abdomen, fever, hepatosplenomegaly

Metastatic malignancy/ Lymphoma

USG guided FNAC- purulent aspirate; Pus cells, small lymphocytes and histiocytes in a caseous necrotic background; AFB – plenty

Tubercular lesion

6

55

M

Left cheek

Slowly growing painless left cheek swelling for about 3 months

Oral cancer

Purulent aspirate; pus cells, small lymphocytes and caseous necrosis; AFB + ve

Tubercular abscess

7

30

F

Left foot

Non-healing ulcer for 4 months

Squamous cell carcinoma

Blood mixed aspirate; Tubercular granuloma; AFB +ve

Tubercular lesion

 

 

 

Amongst a large number of examples, the following two examples were much intriguing to the authors.  

Abdominopelvic tuberculosis is a frequent mimic of malignancy presenting as abdominopelvic lump, ascites with or without raised CA125 level (2, 3).

Tubercular psoas abscess may also evoke clinical suspicion of soft tissue malignancy (4).

These seven cases are merely a few examples of the myriad ways in which tuberculosis can be the source of clinical dilemma and frequent misdiagnosis. FNAC can be a very useful tool for diagnosis of such conditions, at least in a considerable proportion of them.

Acknowledgements

The authors declare that there is no conflict of interests.

  1. Dye C, Scheele S, Dolin P, Pathania V, Raviglione MC. Global Burden of TuberculosisEstimated Incidence, Prevalence, and Mortality by Country. JAMA 1999; 282(7):677-86.
  2. Xi X, Shuang L, Dan W, Ting H, Han MY, Ying C, et al. Diagnostic dilemma of abdominopelvic tuberculosis:a series of 20 cases. J Cancer Res Clin Oncol 2010;136(12):1839-44.
  3. Arora N, Gupta P, Raghunandan C, Jhunjhunwala V. Pelvic tuberculosis in a postmenopausal woman mimicking ovarian malignancy--a clinical dilemma. J Indian Med Assoc 2008;106(9):602-3.
  4. Wijesekera N, Riddell A, Moskovic E. Tuberculous psoas abscess mimicking soft tissue tumor. Br J Hos Med 2010;71(10):593.