Hepatic macronodular tuberculoma mimics liver metastasis in a patient with locoregional advanced tongue cancer
Journal
Journal of Clinical Oncology
Journal Volume
29
Journal Issue
22
Date Issued
2011
Abstract
A 55-year-old man had disseminated tuberculosis involving the lungs and right foot, with initial presentation of complicated right foot cellulitis. He had undergone antituberculosis treatment with combined use of pyrazinamide, rifampin, ethambutol, and isoniazid in April 2005. Other than the persistent abnormal appearance of plain chest radiographs, there were no clinical events thereafter. However, in September 2010, the patient presented with gradual dysphagia and odynophagia. On physical examination, an enlarged and indurated mass was noted on the left hemitongue. Several enlarged, painless, and fixed lymph nodes were palpable on the left upper neck region. Laboratory studies revealed normal blood counts, liver function tests, renal function, and inflammatory biomarkers. Incisional biopsy of the tongue mass confirmed the diagnosis of squamous cell carcinoma (SCC). Contrast-enhanced computed tomography (CT) of the head/ neck, chest, and upper abdomen for pretreatment evaluation revealed locally advanced tongue cancer (Fig 1A; arrow) and lymph node metastases in the left upper neck (Fig 1B; arrowhead). In addition, patchy consolidation with cystic, calcified, and fibronodular change was noted in the left lung (Fig 1C), compatible with pulmonary tuberculosis also confirmed by the subsequent polymerase chain reaction assay for Mycobacterium tuberculosis complex from the patient's sputum. Nevertheless, a hypodense nodule with minimal enhancement, measuring 16 12 mm, was found in segment four of the liver (Figs 2A, 2B; arrows). For further differentiation of the hepatic lesion and whole-body survey of the tongue cancer, fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT was performed, revealing hypermetabolic lesions suggestive of malignancy in the left tongue (Fig 2C;
SDGs
Type
journal article