Korean Journal of Radiology

  • 제2권3호
  • /
  • Pages.138-144
  • /
  • 2001
  • /
  • 1229-6929(pISSN)
  • /
  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

Coexisting Bronchogenic Carcinoma and Pulmonary Tuberculosis in the Same Lobe: Radiologic Findings and Clinical Significance

  • Young Il Kim (Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC) ;
  • Jin Mo Goo (Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC) ;
  • Hyae Young KIm (Department of Radiology, Ilsan National Cancer Center) ;
  • Jae Woo Song (Department of Radiology, Seoul Municipal Boramae Hospital) ;
  • Jung-Gi Im (Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, SNUMRC)
  • 투고 : 2001.02.17
  • 심사 : 2001.06.14
  • 발행 : 2001.09.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: Bronchogenic carcinoma can mimic or be masked by pulmonary tuberculosis (TB), and the aim of this study was to describe the radiologic findings and clinical significance of bronchogenic carcinoma and pulmonary TB which coexist in the same lobe. Materials and Methods: The findings of 51 patients (48 males and three females, aged 48-79 years) in whom pulmonary TB and bronchogenic carcinoma coexisted in the same lobe were analyzed. The morphologic characteristics of a tumor, such as its diameter and margin, the presence of calcification or cavitation, and mediastinal lymphadenopathy, as seen at CT, were retrospectively assessed, and the clinical stage of the lung cancer was also determined. Using the serial chest radiographs available for 21 patients, the possible causes of delay in the diagnosis of lung cancer were analyzed. Results: Lung cancers with coexisting pulmonary TB were located predominantly in the upper lobes (82.4%). The mean diameter of the mass was 5.3 cm, and most tumors (n=42, 82.4%) had a lobulated border. Calcification within the tumor was seen in 20 patients (39.2%), and cavitation in five (9.8%). Forty-two (82.4%) had mediastinal lymphadenopathy, and more than half the tumors (60.8%) were at an advanced stage [IIIB (n=11) or IV (n=20)]. The average delay in diagnosing lung cancer was 11.7 (range, 1-24) months, and the causes of this were failure to observe new nodules masked by coexisting stable TB lesions (n=8), misinterpretation of new lesions as aggravation of TB (n=5), misinterpretation of lung cancer as tuberculoma at initial radiography (n=4), masking of the nodule by an active TB lesion (n=3), and subtleness of the lesion (n=1). Conclusion: Most cancers concurrent with TB are large, lobulated masses with mediastinal lymphadenopathy, indicating that the morphologic characteristics of lung cancer with coexisting pulmonary TB are similar to those of lung cancer without TB. The diagnosis of lung cancer is delayed mainly because of masking by a tuberculous lesion, and this suggests that in patients in whom a predominant or growing nodule is present and who show little improvement of symptoms despite antituberculous or other medical therapy, coexisting cancer should be suspected.

키워드

참고문헌

  1. Neeussle WF. Association of bronchogenic carcinoma and active pulmonary TB: Report of 4 cases. Dis Chest 1953;23:207-216  https://doi.org/10.1378/chest.23.2.207
  2. Steinitz R. Pulmonary TB and carcinoma of the lung: A survey from two population-based disease registers. Am Rev Respir Dis 1965;92:758-766 
  3. Tunell WP, Koh Y-C, Adkins PC. The dilemma of coincident active pulmonary TB and carcinoma of the lung. J Thorac Cardiovasc Surg 1971;62:563-567  https://doi.org/10.1016/S0022-5223(19)42025-4
  4. Ting YM, Chirch WM, Ravikrishnan KP. Lung carcinoma superimposed on pulmonary TB. Radiology 1976;119:307-312  https://doi.org/10.1148/119.2.307
  5. Fontenelle LJ, Campbell D. Coexisting bronchogenic carcinoma and pulmonary TB. Ann Thorac Surg 1970;9:431-435  https://doi.org/10.1016/S0003-4975(10)65535-X
  6. Mok CK, Nandi P, Ong GB. Coexistent bronchogenic carcinoma and active pulmonary TB. J Thorac Cardiovasc Surg 1978;76:469-472  https://doi.org/10.1016/S0022-5223(19)41073-8
  7. Limas C, Japaze H, Gracia-Bunuel R. Scar carcinoma of the lung. Chest 1971;59:219-222  https://doi.org/10.1378/chest.59.2.219
  8. Bayle CH. Recherches sur la phitisue pulmonaire. Paris, France: Galon, 1810 
  9. Raeburn G, Spencer H. Lung scar cancer. Br J Tuberc Dis Chest 1957;51:237-245  https://doi.org/10.1016/S0366-0869(57)80080-X
  10. Ripstein CB, Spain DM, Bluth I. Scar cancer of the lung. J Thorac Cardiovasc Surg 1968;56:362-370  https://doi.org/10.1016/S0022-5223(19)42827-4
  11. Gopalakrishnan P, Miller JR, Mclaughlin JS. Pulmonary TB and coexisting carcinoma. Am Surg 1975;41:405-408 
  12. Ben M'Rad S, Azzabi S, Baccar MA, Aouina H, Bouacha H, Nacef T. Broncho-pulmonary cancer associated with pulmonary TB: Report of 4 cases. Rev Pneumol Clin 1998 Feb;54:23-25 
  13. Edwards C, Carlile A. Scar adenocarcinoma of the lung: a light and electron microscopic study. J Clin Pathol 1986;39:423-427  https://doi.org/10.1136/jcp.39.4.423
  14. Shimosato Y, Hashimoto T, Kodama T, et al. Prognostic implications of a fibrotic focus (scar) in small peripheral lung cancers. Am J Surg Pathol 1980;4:625-631  https://doi.org/10.1097/00000478-198008000-00005
  15. Renato B. Berroya, John W. Polk, Radma Raju, Alan H. Bailey. Concurrent pulmonary TB and primary carcinoma. Thorax 1971;26:384-387 https://doi.org/10.1136/thx.26.4.384