Hepatic tuberculoma mimicking hepatocellular carcinoma in an immunocompetent host

Zorbas, Konstantinos A.; Koutoulidis, Vassilis; Foukas, Pericles; Arkadopoulos, N.

doi:10.1136/bcr-2013-008775

Cited by 13 publications

(10 citation statements)

References 8 publications

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“…The disease may present at any age but is often seen in young adults [3] . As far as clinical findings are concerned, TB is most frequently associated with hepatomegaly (90%), fever (70%), weight loss (60%), abdominal pain (50%) night sweats, anorexia and rarely jaundice [4] . Our patient was admitted with all of the abovementioned signs.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Dilemma of Hepatic Tuberculosis in Presence of Portal Hypertension: A Rare and Relevant Case

Aharbil¹,

Boudda²,

Errami³

et al. 2022

ijirms

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Tuberculosis (TB) is and remains a growing public health problem worldwide, especially in developing countries. Hepatic tuberculosis is an extremely rare form of extra pulmonary TB. Our case report describes hepatic tuberculosis revealed by an atypical sign: portal hypertension (PHT) in a Moroccan immuno competent young man. Case Report: A 28-year-old male with no medical history, was admitted with an abundant ascites, and a chronic right hypochondrium pain. The biology data found a low protein concentration ascitic fluid with signs of portal hypertension in the abdominal ultra sound (US). An abdominal CT scan demonstrated a multi nodular liver with profound multiple lymph nodes some with a necrotic center. The diagnosis of multifocal tuberculosis was clinched on by the positivity of Xpert MTB/RIF assay on sputum and on hepatic needle biopsy. Conclusion: Portal hypertension secondary to hepatic tuberculosis is exceptional and often causes a diagnostic dilemma. It should be considered in the differential diagnosis of non-cirrhotic portal hypertension especially in endemic areas.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Dilemma of Hepatic Tuberculosis in Presence of Portal Hypertension: A Rare and Relevant Case

Aharbil¹,

Boudda²,

Errami³

et al. 2022

ijirms

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“…One patient with tuberculosis masqueraded as large HCC on imaging. It is worthwhile to perform biopsy if atypical features are present on imaging [17] . Large adenomas require resection as they have potential for rupture and malignancy [18] .…”

Section: Discussionmentioning

confidence: 99%

Surgery for liver tumors that are close to major vascular structures of future liver remnant

Thumma¹,

Gunturi²,

K³

et al. 2019

Int. J. Surg. Sci.

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Introduction: In patients with just enough future liver remnant (FLR) parenchymal transection preserving all the inflow or venous outflow of FLR is very important. Tumors close to the major hilar vessels or to the outflow of FLR pose unique challenges for assessment of resectability. In both benign and malignant conditions which are close to major vessels of FLR meticulous surgery is required to obtain good outcomes. Hence, we looked at the data of such tumors which are close to the inflow and outflow of FLR and studied the surgical feasibility and perioperative outcomes. Aim: The aim of the present study was to study the perioperative results of resection of tumors close to the inflow or outflow of future liver remnant. Material and methods:The study was a retrospective study conducted in the Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad between 2015 to 2018.All tumors of the liver which were close (<1cm) to the inflow or outflow of the FLR were included in the study. Both benign and malignant tumors close to major vasculature of FLR were included. The surgical feasibility, complications and R0 resection rate was studied. Intraoperative and postoperative complications were studied. Results: Twenty three patients were included in the study. The mean age of the patients was 43.8(8-68) yrs. There were 8 patients with tumors close to outflow, 9 to inflow and 6 to both inflow and outflow of FLR. Preoperatively the diagnosis was benign in 6 (6/23, 26%). They were included in the study because of their critical location and proximity to the vasculature of FLR. Seven patients had a large SOL in liver (>9cm). One patient underwent 2 stage hepatectomy because of hemodynamic instability. The final histopathology was HCC in 4, Hepatoblastoma 1, Adenoma 1 and Tuberculosis in 1. Seven patients with hilar mass underwent surgery (3 had hilar cholangiocarcinoma, 1 intrahepatic cholangiocarcinoma and 3 benign). Segmentectomy was done in 3 (1 colorectal liver metastasis, 2 HCC with CLD) The final biopsy was malignancy in 12 patients. Two (2/12, 16.6%) of them had a positive resection margin). Five patients (5/ 17, 29%) with preoperative suspicion of malignancy had a benign etiology (1 adenoma, 2 tuberculosis, 2 granular cell tumor) on final histopathology. There was 1(1/23, 4.3%) mortality in our series due to bile leak and fungal sepsis. Two patients had transient liver failure (Grade II). Six (5 Grade II, 1 Grade V) patients had transient bile leak. Conclusion: Tumors close to inflow or outflow of FLR can be resected with acceptable morbidity and mortality.

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“…To our knowledge, similar cases have not been of such a small size. [ 4 – 6 ] Furthermore, this is the first report on contrast-enhanced US findings of hepatic isolated TB. We discuss the findings of noninvasive imaging modalities of hepatic TB.…”

Section: Introductionmentioning

confidence: 91%

“…However, due to non-specific imaging manifestation, hepatic TB may cause a diagnostic dilemma. [ 4 ] It may be misdiagnosed as a liver tumor, such as intrahepatic carcinoma or metastasis, or other lesions, such as liver abscess or hydatid cyst and so on. [ 5 – 9 ] Here, we report a case of isolated hepatic TB with primary misdiagnosis as small hepatocellular carcinoma (HCC) on contrast-enhanced ultrasonography (US) and magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

Primary isolated hepatic tuberculosis mimicking small hepatocellular carcinoma

Yang¹,

Liu²,

Ling³

et al. 2020

Medicine

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Rationale: Mycobacterium tuberculosis (TB) remains a serious threat in developing countries. Primary isolated hepatic tuberculosis is extremely rare. Because of its non-specific imaging features, noninvasive preoperative imaging diagnosis of isolated hepatic tuberculoma remains challenging. Patient concerns: A 48-year-old man was admitted to our hospital due for suspected liver neoplasm during health examination. Diagnoses: The tests for blood, liver function, and tumor markers were within normal range. Preoperative ultrasonography (US) showed a hypoechoic lesion with a longitudinal diameter of 2.5 cm in segment six of liver. It exhibited early arterial phase hyperenhancement and late arterial phase rapid washout in contrast-enhanced US. It demonstrated hyperintensity in T2-weighted magnetic resonance imaging and partly restricted diffusion in diffusion-weighted imaging. For this nodule, the preoperative diagnosis was small hepatocellular carcinoma (HCC). Interventions: Laparoscopic hepatectomy was performed. Intraoperative extensive adhesion in the abdominal cavity and liver was found. The lesion had undergone expansive growth. Outcomes: Microscopically, a granuloma with some necrosis was detected. With both acid-fast staining and TB fragment polymerase chain reaction showing positive results, TB was the final histology diagnosis. After surgery, the patient declined any anti-TB medication. During the follow-up, he had no symptoms. In the sixth month after surgery, he underwent an upper abdominal US. It showed no lesions in the liver. Lessons: Because of non-specific imaging findings and non-specific symptoms, a diagnosis of isolated hepatic TB is difficult to make, especially for small lesions. A diagnosis of HCC should be made cautiously when small isolated lesions in the liver are encountered, especially in patients without a history of hepatitis and with negative tumor markers.

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Hepatic tuberculoma mimicking hepatocellular carcinoma in an immunocompetent host

Cited by 13 publications

References 8 publications

Diagnostic Dilemma of Hepatic Tuberculosis in Presence of Portal Hypertension: A Rare and Relevant Case

Diagnostic Dilemma of Hepatic Tuberculosis in Presence of Portal Hypertension: A Rare and Relevant Case

Surgery for liver tumors that are close to major vascular structures of future liver remnant

Primary isolated hepatic tuberculosis mimicking small hepatocellular carcinoma

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