ORIGINAL ARTICLE

The nodular form of hepatic tuberculosis: a review with five additional new cases

W-T Huang¹, C-C Wang², W-j Chen¹, Y-F Cheng³, H-L Eng¹

¹ Department of Pathology, Chang Gung University and Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan
² Department of Surgery, Chang Gung University and Memorial Hospital
³ Department of Radiology, Chang Gung University and Memorial Hospital

Correspondence to:
Correspondence to:
Dr H-L Eng
Department of Pathology, Kaohsiung Medical Center, Chang Gung Memorial Hospital, 123, Ta-pei Road, Niao-Sung Hsiang, Kaohsiung County, Taiwan; eng6166{at}ms8.hinet.net

Background: Tuberculosis presenting as an isolated liver tumour, without active pulmonary or miliary tuberculosis, or other clinical evidence of tuberculosis, is distinctly rare. A greater awareness of this rare clinical entity may prevent needless surgical intervention.

Aims: To help characterise this distinctly rare presentation of tuberculosis, five new cases are presented, together with a review of the world literature. The clinical, laboratory, radiological, and pathological features of these patients are described.

Methods: Polymerase chain reaction (PCR) assay of the liver tissue was carried out in all cases to confirm an aetiological diagnosis of Mycobacterium tuberculosis infection.

Results: All five patients (44–71 years old; two women, three men) underwent surgery, and had a preoperative diagnosis of malignant hepatic neoplasm and a postoperative histological diagnosis of chronic granulomatous inflammation, suggestive of tuberculosis. None of them had a known previous history of tuberculosis. All of them were positive for M tuberculosis by PCR analysis of the liver tissue.

Conclusions: This report illustrates the difficulty in reaching a correct preoperative diagnosis. It is usually unsuspected and confused with primary or metastatic carcinoma of the liver, especially when it coexists with other malignancies. A high index of suspicion is required for diagnosis, which can be made only by histological and bacteriological studies, and PCR analysis.

Keywords: Polymerase chain reaction; hepatic granulomatous inflammation; hepatic tuberculoma; hepatic tuberculosis

Abbreviations: AFB, acid fast bacilli; ALP, alkaline phosphatase; CT, computed tomography; PCR, polymerase chain reaction

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?