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Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e3181757ad4
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Pulmonary Tuberculosis Mimicking Lung Metastasis

Paci, Massimiliano MD*; Cavazza, Alberto MD†; Ferrari, Guglielmo MD*; Filice, Angelina MD‡; Sgarbi, Giorgio MD§

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*Division of Thoracic Surgery, Azienda Ospedaliera Santa Maria Nuova, Italy; †Department of Pathology, Azienda Ospedaliera Santa Maria Nuova, Viale Risorgimento No. 80, 42 100 Reggio Emilia, Italy; ‡Unit of Nuclear Medicine—PET center, Azienda Ospedaliera Santa Maria Nuova, Italy; and §Division of Thoracic Surgery, Azienda Ospedaliera Santa Maria Nuova, Italy.

Disclosure: The authors have no financial disclosures or vested interests for this work.

Address for correspondence: Massimiliano Paci, MD, Division of Thoracic Surgery, Azienda Ospedaliera Santa Maria Nuova, Viale Risorgimento n° 80, 42 100 Reggio Emilia, Italy. E-mail: paci.massimiliano@asmn.re.it

A 72-year-old male had a history of a T3N0 colorectal carcinoma in 2005 and right hepatectomy in 2006 for a single liver metastasis. The patient underwent adjuvant chemotherapy. The CT scan of the chest 6 months after hepatectomy revealed multiple bilateral pulmonary nodular lesions (Figure 1). There was no history of fever, weight loss or productive cough. Tumor markers (CEA, CA 19.9) were negative. Positron emission tomography with 18 F-FDG (FDG-PET) showed that the pulmonary lesions had a high uptake suggestive of malignancy (Figure 2). There was no evidence of mediastinal or distant lesions. Fiberoptic bronchoscopy was negative.

Figure 1
Figure 1
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Figure 2
Figure 2
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The patient underwent multiple wedge resections of the right lung. The lung tissue was completely embedded for histologic examination. The biopsy demonstrated numerous well-formed, bronchiolocentric granulomas with large areas of necrosis (Figure 3). With Ziehl-Neelsen stain, a few mycobacteria were detected in the necrotic material. No carcinoma was identified.

Figure 3
Figure 3
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The patient was treated with a regimen of isoniazid 300 mg, rifampin 600 mg, ethambutol 1 g, daily for 6 months, combined with pyrazinamide 2 g daily for the first 2 months. A repeat HRCT scan of the chest 6 months after the start of treatment revealed significant reduction of the bilateral nodules. This case shows that pulmonary tuberculosis can manifest as pulmonary nodules mimicking lung metastasis. Accordingly, nodules of the lung in a patient with a previous neoplasm should be histologically documented to be malignant before starting chemotherapy.

Cited By:

This article has been cited 2 time(s).

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Characterization of Hilar and Mediastinal Foci on F-18-FDG PET: New Variables
Basu, S
Journal of Nuclear Medicine, 50(3): 489-490.
10.2967/jnumed.108.059683
CrossRef
Medical Science Monitor
FDG/PET uptake in asymptomatic multilobar Chlamydia pneumoniae pneumonia
Bianco, A; Mazzarella, G; Rocco, D; Gasperi, M; Di Marco, R; Brunese, L
Medical Science Monitor, 16(6): CS67-CS70.

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Keywords:

Tuberculosis; lung metastasis; chemotherapy; colorectal carcinoma

© 2008International Association for the Study of Lung Cancer

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