Tuberculosis (T.B.) masquerading as tumor. An 8-year study on 25 cases of long bone tuberculosis presenting as tumors

Abstract

Aim: To highlight radiological features and emphasize the need for tissue diagnoses to confirm bone pathology. Tuberculosis is known to present without constitutional symptoms and with unconventional imaging features mimicking sarcomas as shown in our series of 25 patients; where the imaging and biopsy protocols at our institute helped to solve these diagnostic dilemmas. Material and methods: We retrospectively analyzed clinical and radiological features and tissue diagnoses in 25 patients referred to the department of orthopedic oncology with radiological suspicion of tumor. Results: Only 7 patients had cultures positive for Mycobacterium Tuberculosis T.B. Radiological features suggestive of infection were Metaphyseal and joint involvement, permeative lesions, absence of Codman’s triangle, and soft tissue mass suggestive of a cold abscess. The predictive accuracy of the orthopedic oncologist was 60% and musculoskeletal radiologist was 72% (based on radiology). Final diagnosis is 100% confirmed on histopathology. Conclusion: Diagnosis based primarily upon imaging is a wrong approach. A multimodal approach to differentiating tuberculous bone infections from sarcomas is essential.

Diagnosis of Osteoarticular Tuberculosis: Perceptions, Protocols, Practices, and Priorities in the Endemic and Non-Endemic Areas of the World—A WAIOT View

“…It is best to inform the microbiologist about the suspicion so that appropriate tests are carried out. Another important feature in NTM infections that helps in early diagnosis is a positive smear for acid-fast bacilli and negative GeneXpert [ 75 , 76 , 77 , 78 , 79 , 80 ]. The incidence of these infections is sizeable.…”

“…The other diagnoses to be entertained are tumors and pigmented villonodular synovitis in the appendicular skeleton, herniated disc, canal stenosis, and mechanical back pain in cases of spinal TB [ 78 , 79 ].…”

Evaluation of patients admitted with musculoskeletal tuberculosis: sixteen years’ experience from a single center in Turkey

“…Although pulmonary TB has been extensively covered in the literature [ 6 – 8 ], publications on musculoskeletal TB are relatively limited, and have been reported mostly in case reports [ 9 – 11 ]. In addition, the diagnosis of musculoskeletal system TB can be challenging, particularly for the physicians who are not familiar, because TB can present in atypical locations and mimic tumoral lesions [ 12 ]. Therefore, a biopsy should be taken to confirm the diagnosis.…”

Evaluation of patients admitted with musculoskeletal tuberculosis: sixteen years’ experience from single center in Turkey

“…Although pulmonary TB has been extensively covered in the literature (6)(7)(8), publications on musculoskeletal TB are relatively limited, and have been reported mostly in case reports (9)(10)(11). In addition, the diagnosis of musculoskeletal system TB can be challenging, particularly for the physicians who are not familiar, because TB can present in atypical locations and mimic tumoral lesions (12). Therefore, a biopsy should be taken to con rm the diagnosis.…”