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Vol.49 No.7 contents | Japanese/English |
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- Case Report -
A Case of Coexisting Lung Cancer and Mediastinal Tuberculous Lymphadenitis
Junji Ichinose1, Tadasu Kohno1, Sakashi Fujimori1, Tomoharu Yoshiya1, Masateru Kawabata21Department of Thoracic Surgery, Toranomon Hospital, Japan, 2Department of Respiratory Medicine, Toranomon Hospital Kajigaya, Japan
Background. Mediastinal tuberculous lymphadenitis in adults is relatively rare, and often presents difficulties in distinguishing it from metastasis of lung cancer. Case. A series of nodules in both lungs and enlarged pretracheal and right hilar lymph nodes were found in a 67-year-old man, who was a heavy-smoker. He had chronic renal failure and had been treated by hemodialysis. The result of mycobacterial examinations was negative. Considering laboratory studies and positron emission tomography, the lesion was likely to be primary lung cancer. However, we made a diagnosis of tuberculosis by thoracoscopic mediastinal lymph node biopsy. After antituberculosis treatment, the nodule in the right upper lobe and enlarged lymph nodes reduced in size remarkably, but the nodule in the left upper lobe increased rapidly. We performed video-assisted thoracic lobectomy with lymph node dissection and the pathological findings revealed primary lung cancer (squamous cell carcinoma, pT1N0M0, stage IA). Conclusion. Mediastinal tuberculous lymphadenitis presents a problem regarding bacteriologic confirmation of the diagnosis and sometimes shows strong accumulation on PET image resembling lung cancer. We should pay more attention to the strong possibility of the development of lung cancer in patients with tuberculosis and carefully examine the coexistence of lung cancer.
key words: Lung cancer, Mediastinal tuberculous lymphadenitis, PET
Received: December 4, 2008
Accepted: July 30, 2009
JJLC 49 (7): 1043-1048, 2009
