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.
| Article View | 2,078 |
| PDF Download | 1,098 |
