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Tuberculosis masquerading as malignancy: a multimodality approach to the correct diagnosis - a case report.

Amukotuwa S, Choong PF, Smith PJ, Powell GJ, Slavin J, Schlicht SM - Int Semin Surg Oncol (2005)

Bottom Line: As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy.Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy.The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Imaging, St, Vincent's Hospital, Fitzroy 3065, Melbourne, Australia. shalini.AMUKOTUWA@svhm.org.au.

ABSTRACT
BACKGROUND: Extrapulmonary tuberculosis is one of the great mimickers of medicine, and often masquerades as malignancy. As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy. CASE PRESENTATION: We present the case of a 21 year old man with tuberculous osteomyelitis, who was referred to the Bone and Soft Tissue Sarcoma Service at our institution with a provisional diagnosis of malignancy. Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy. The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made. CONCLUSION: This case highlights the importance of remaining cognisant of the protean manifestations of extrapulmonary tuberculosis, and illustrates the advantage of a clinically directed multi-modality imaging approach to diagnosis.

No MeSH data available.


Related in: MedlinePlus

CT guided biopsy of the para-aortic lymph nodes. A. 14 gauge core needle biopsy. B. The core of tissue obtained. C. Histological examination after haematoxylin and eosin staining, demonstrating classic caseating granulomata of tuberculous infection (arrowed).
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Figure 11: CT guided biopsy of the para-aortic lymph nodes. A. 14 gauge core needle biopsy. B. The core of tissue obtained. C. Histological examination after haematoxylin and eosin staining, demonstrating classic caseating granulomata of tuberculous infection (arrowed).

Mentions: Subsequent CT guided biopsy of the retroperitoneal lymphoid tissue revealed necrotising granulomatous lymphadenitis indicative of Mycobacterium tuberculosis infection (Figure 11). While no acid fast bacilli were visible on Ziehl-Nielsen staining, polymerase chain reaction was positive for M. tuberculosis DNA. The lymph node biopsy specimens cultured M. tuberculosis after 6 weeks.


Tuberculosis masquerading as malignancy: a multimodality approach to the correct diagnosis - a case report.

Amukotuwa S, Choong PF, Smith PJ, Powell GJ, Slavin J, Schlicht SM - Int Semin Surg Oncol (2005)

CT guided biopsy of the para-aortic lymph nodes. A. 14 gauge core needle biopsy. B. The core of tissue obtained. C. Histological examination after haematoxylin and eosin staining, demonstrating classic caseating granulomata of tuberculous infection (arrowed).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1131917&req=5

Figure 11: CT guided biopsy of the para-aortic lymph nodes. A. 14 gauge core needle biopsy. B. The core of tissue obtained. C. Histological examination after haematoxylin and eosin staining, demonstrating classic caseating granulomata of tuberculous infection (arrowed).
Mentions: Subsequent CT guided biopsy of the retroperitoneal lymphoid tissue revealed necrotising granulomatous lymphadenitis indicative of Mycobacterium tuberculosis infection (Figure 11). While no acid fast bacilli were visible on Ziehl-Nielsen staining, polymerase chain reaction was positive for M. tuberculosis DNA. The lymph node biopsy specimens cultured M. tuberculosis after 6 weeks.

Bottom Line: As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy.Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy.The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Medical Imaging, St, Vincent's Hospital, Fitzroy 3065, Melbourne, Australia. shalini.AMUKOTUWA@svhm.org.au.

ABSTRACT
BACKGROUND: Extrapulmonary tuberculosis is one of the great mimickers of medicine, and often masquerades as malignancy. As a result, patients may be referred to oncologists and surgeons for further evaluation and management, delaying the institution of appropriate anti-tuberculous drug therapy. CASE PRESENTATION: We present the case of a 21 year old man with tuberculous osteomyelitis, who was referred to the Bone and Soft Tissue Sarcoma Service at our institution with a provisional diagnosis of malignancy. Further investigation revealed extensive retroperitoneal abdominal and pelvic lymphadenopathy. The recognition of certain patterns on imaging, and finally the isolation of Mycobacterium tuberculosis from tissue samples obtained under image guidance, enabled the correct diagnosis to be made. CONCLUSION: This case highlights the importance of remaining cognisant of the protean manifestations of extrapulmonary tuberculosis, and illustrates the advantage of a clinically directed multi-modality imaging approach to diagnosis.

No MeSH data available.


Related in: MedlinePlus