Hepatic Tuberculosis Mimicking Metastasis in a Case of Carcinoma Sigmoid Colon

Abstract

Tuberculosis (TB) presenting as isolated liver mass without clinical evidence of TB is difficult to diagnose preoperatively and is usually mimicked by primary or metastatic carcinoma of the liver. Hepatic TB associated with carcinoma colon is a rare association which has very rarely been reported in the literature. This case illustrates the diagnostic difficulties of hepatic TB and the need to consider it in the differential diagnosis of hepatic nodular lesions in carcinoma colon patients. Here, we report a case of 48-year-old female who presented in the casualty with features of acute intestinal obstruction. Preoperatively a mass was seen at the hepatic flexure along with three lesions in the liver presumed to be metastatic in origin. However, histopathology of the mass revealed adenocarcinoma colon and the liver lesion proved to be hepatic TB. We wish to highlight that on encountering a hepatic lesion in a carcinoma colon patient the possibility of hepatic TB should also be kept in mind apart from the obvious possibility of metastasis especially in an endemic country like India.

Hepatic tuberculosis with lower gastrointestinal symptoms mimicking hepatic metastasis: A rare case report

“…During physical exam, hepatomegaly emerges as the most common physical finding, observed in approximately 96 % of cases [ 2 ] and splenomegaly occurring in a range of 18 % to 55 % of cases [ 7 ]. It's worth noting that neither splenomegaly nor hepatomegaly was evident in our specific case.…”

“…The diagnosis of diffuse hepatic TB was confidently made on the basis of the similar findings across these samples. The histological examination, which continues to be the most accurate method for diagnosing abdominal visceral TB, was used as the foundation for this result due to its strong evidence [ 2 ].…”

“…The study adheres to the SCARE criteria in its reporting [ 1 ]. Mycobacterium poses a widespread global health challenge, notably affecting regions like the Indian subcontinent [ 2 ]. While developed countries have seen an uptick in cases due to secondary immunosuppression caused by conditions such as cancer and HIV (human immunodeficiency virus) infections, developing nations grapple with tuberculosis primarily due to poor socioeconomic conditions [ 3 ].…”

“…This disease's significant impact on developing nations results in a staggering death toll of approximately 2,000,000 each year [ 4 ]. While the lungs are the primary focus, other body parts can also be affected, with the abdomen being particularly susceptible (at rates ranging from 6 % to 38 %) [ 2 ]. Abdominal visceral tuberculosis is a usual health issue in the Indian subcontinent, affecting multiple organs including liver [ 3 ].…”

“…Incidence estimates for hepatic TB stand at around 1 % of all active TB cases, and isolated liver TB accounts for <1 % of total cases [ 5 ]. The infrequency of hepatic TB is attributed to the liver's low oxygen tension, rendering the environment unfavorable for the growth of Mycobacterium tuberculosis [ 2 , 4 ]. The liver's engagement in both pulmonary and extrapulmonary tuberculosis often remains without noticeable clinical manifestations.…”