Journal of Cytology
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LETTER TO EDITOR  
Year : 2015  |  Volume : 32  |  Issue : 3  |  Page : 210-211
Coexistence of metastatic carcinoma in the lung and tuberculosis


1 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India
2 Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India

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Date of Web Publication9-Nov-2015
 

How to cite this article:
Mitra S, Dey P. Coexistence of metastatic carcinoma in the lung and tuberculosis. J Cytol 2015;32:210-1

How to cite this URL:
Mitra S, Dey P. Coexistence of metastatic carcinoma in the lung and tuberculosis. J Cytol [serial online] 2015 [cited 2020 Jan 23];32:210-1. Available from: http://www.jcytol.org/text.asp?2015/32/3/210/168907


Sir,

There are rare cases in which metastatic malignancies are seen to be associated with an infectious pathology. However, in developing and underdeveloped countries, these cases are seen at a relatively higher frequency. There are occasional case reports where metastatic malignancies are found to be associated with infectious diseases, especially tuberculosis. [1] Here, we present a case of metastatic carcinoma in the lung coexisting with tuberculosis.

The patient was a 38-year-old male with a biopsy diagnosis of transitional cell carcinoma involving the nose, paranasal sinus, and nasopharynx. The patient was referred to our institute with shortness of breath and hemoptysis for 15 days, prior to his presentation. Computed tomography (CT) scan of the chest revealed multiple mass lesions in both the lungs and the possibility of metastatic lesions was entertained.

CT-guided fine-needle aspiration cytology (FNAC) smears from the mass lesions in the lung showed tumor cells in clusters as well as in a dispersed population. There were two cell populations predominantly showing clusters and dispersed population of round to oval cells with coarse chromatin, prominent nucleoli, and a moderate amount of cytoplasm [Figure 1]a. Many of the cells showed vacuolated cytoplasm. Another population of cells showed predominantly spindle cell morphology with similar chromatin architecture. The background showed scattered alveolar macrophages. In addition, there were occasional epithelioid cell granulomas [Figure 1]b and collection of epithelioid histiocytes [Figure 1]c. The Giemsa stained smear was destained and restained with Ziehl-Neelsen stain to demonstrate the presence of acid-fast bacilli [Figure 1]d.
Figure 1: (a) Malignant cell clusters with round nuclei, coarse chromatin, and prominent nucleoli (MGG, ×420) (b) Epithelioid cell granuloma in cytology smear (MGG, ×420) (c) Epithelioid histiocytes in cytology smears (MGG, ×1200) (d) Occasional acid-fast bacilli in cytology smear (Ziehl-Neelsen stain, ×1,200)

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This patient had multiple metastases in the lung that showed cytological features of malignancy (carcinoma). We have access to the report of the primary tumor in the paransal sinus (transitional cell carcinoma). However, unfortunately, we could not retrieve the slides from the patient. The lung FNAC slides showed unequivocal malignancies, along with tuberculosis.

There are a few case reports of malignancies coexisting with tuberculosis in different settings including metastatic squamous cell carcinoma in the lymph node with coexisting tuberculosis, [1] coexistence of breast cancer with tuberculosis in the breast and axillary lymph nodes, [2],[3] and coexistence with bronchogenic carcinoma and non-Hodgkin's lymphoma. [4] A review of the literature reveals that deterioration of immunity due to local or systemic effects of the tumor itself and/or administered chemotherapeutics or radiotherapy may play a role in the reactivation of tuberculosis, increasing the morbidity and mortality in patients with various malignancies. [4] So, in countries with a high prevalence of tuberculosis such as India, a possibility of tuberculosis should always be considered in malignancies or metastatic malignancies in the lymph node and lungs and Ziehl-Neelsen stain should be done if there is any indirect evidence of tuberculosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Barwad A, Gowda KK, Dey P. Co-existent of tuberculosis and squamous cell carcinoma in a lymph node diagnosed by fine needle aspiration cytology. Cytopathology 2012;23:276-7.  Back to cited text no. 1
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2.
Akbulut S, Sogutcu N, Yagmur Y. Coexistence of breast cancer and tuberculosis in axillary lymph nodes: A case report and literature review. Breast Cancer Res Treat 2011;130:1037-42.  Back to cited text no. 2
    
3.
Baslaim MM, Al-Amoudi SA, Al-Ghamdi MA, Ashour AS, Al-Numani TS. Case report: Breast cancer associated with contralateral tuberculosis of axillary lymph nodes. World J Surg Oncol 2013;11:43.  Back to cited text no. 3
    
4.
Karnak D, Kayacan O, Beder S. Reactivation of pulmonary tuberculosis in malignancy. Tumori 2002;88:251-4.  Back to cited text no. 4
    

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Correspondence Address:
Pranab Dey
Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.168907

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