Kazan State Medical UniversityKamran KhanGrp No-1520Topic-TuberculomaDeperments of tuberculosis

Tuberculoma

• A tuberculoma is a clinical manifestation of tuberculosis which conglomerates tubercles into a firm lump, and so can mimic cancer tumors of many types in medical imagingstudies.[1][2][3] Since these are evolutions of primary complex, the tuberculomas may contain within caseum or calcifications.

General

With the passage of time Mycobacterium tuberculosis (also called Bacillus Koch) can transform into crystals of calcium. These can affect any organ such as the brain,intestine,ovaries,breast,lungs,esophagus,intestine,liver,pancreas,bones,and many others.As the histologic and clinical indications, as well as tumor markers such as the CA-125, are similar, it is often difficult to differentiate tuberculoma from cancer. For these reasons, tuberculosis should always be considered in the differential diagnosis of cancer.

Showing solitary pulmonary nodule on chest x-ray. (b) CT scan of same patient showing the mass posteriorly

in right lower lobe.

Investigations

Routine hematological & biochemical investigations - Normal

CSF examination • TLC – 440 cells

Lymphocytes – 95%

Polymorphs – 5%• Proteins – 111 mg%• Sugar – 21 mg%• Corresponding blood sugar 171 mg%.• AFB, Gram’s stain & India ink staining normal• TB PCR report awaited.

Tuberculoma & Calcified tuberculoma

Treatment of tuberculoma

The mean duration of anti-TB treatment was 11.7±3.7 months (6–25). Isoniazid, rifampicin, ethambutol and pyrazinamide were prescribed for 38 patients initially, and isoniazid, rifampicin and ethambutol were prescribed for another six patients. Ethambutol, streptomycin, cycloserine and levofloxacin were initially given for one patient with poor liver function. The mean treatment duration of the patients treated with regimens including pyrazinamide was shorter than that of the patients treated without pyrazinamide

Response of pulmonary tuberculomas to anti-tuberculous treatment

The resected specimen is a yellowish-white and irregular mass, and 4.5 cm in maximum diameter; and B and C, Histopathological examinations reveal

caseous necrosis, epithelioid cell granuloma, and multinucleated Langhans' giant cells (Hematoxylin and eosin staining. B, upper, ×4; and C, lower, ×20).

Clinical presentationThe primary infection is usually asymptomatic (majority of cases), although a small number go on to have symptomatic haematological dissemination which may result inmiliary tuberculosis. Only in 5% of patients, usually those with impaired immunity, go on to have progressive primary tuberculosis.

pulmonary tuberculosis developed a syndpulmonary tuberculosis developed a syndrome resembling adult respiratory distress following initiation of drug treatment. They were studied clinically and with a representative range of in vitro and in vivo tests of immune function. Both were alcoholic, malnourished and presented with radiologically widespread, smear-positive disease and lymphocytopenia. One had cutaneous anergy in vivo and profound reduction on mononuclear cell proliferative and interferon responses to tuberculoprotein (PPD) in vitro; the other patient, who died two weeks after starting treatment, had relatively normal values for these measures of cell-mediated immunity. In both cases there was a progressive increase during treatmenrome resembling adult respiratory distress following initiation of drug treatment. They were studied clinically and with a representative range of in vitro and in vivo tests of immune function. Both were alcoholic, malnourished and presented with radiologically widespread, smear-positive disease and lymphocytopenia. One had cutaneous anergy in vivo and profound reduction on mononuclear cell proliferative and interferon responses to tuberculoprotein (PPD) in vitro; the other patient, who died two weeks after starting treatment, had relatively normal values for these measures of cell-mediated immunity. In both cases there was a progressive increase during treatmen

Tuberculomas of the lung are one of the more common lesions presenting a solitary pulmonary nodule, roentgenographically. We treated 36 patients with such nodules and describe here the radiologic-pathologic correlations and surgical treatment. In 21 patients, lung cancer was suspected preoperatively, based on radiographic findings of an ill-defined margin,

We propose that the reactions may represent local manifestations of heightened delayed hypersensitivity, mounted by increasing numbers of ‘resuscitated’ lymphocytes against immunogenic cell wall substances released from dying tubercle bacilli In patients whose level of cellular immunity is being enhanced as a result of chemotherapy. The likelihood of an acute respiratory reaction during treatment may therefore depend on the bacillary load, the extent of lung disease present, and its severity may be related to the pre-treatment immune status of the patient.

The majority of pulmonary tuberculomas were decreased by anti-tuberculosis treatment during and even after treatment, although a transient enlargement during the early period of treatment was observed infrequently.

occurred that led to the recognition of intracranial tuberculomata. CT brainscans suggested tuberculomata in all 10 patients; there were several lesions in five and histologicaf confirmation was obtained in three cases. Earlier CT brain scans (six weeks to five months before) were carried out in five patients and in none was a tuberculoma seen. After treatment with anti-tuberculous drugs and control of raised intracranial pressure when present, five patients made a full recovery

symptoms and/or signs

Pulmonary tuberculomas mimicking lung cancer, most of which were pathologically active lesions, commonly displayed abnormal appearances in CT scan and an increase in FDG uptake, similar to changes seen on malignancy. Coexistent lymphadenopathy made differential diagnosis even more complicated. These results suggested that positive FDG PET/CT findings should be interpreted with caution in tuberculosis-endemic regi

tuberculomas of the lung are one of the more common lesions presenting a solitary pulmonary nodule, roentgenographically. We treated 36 patients with such nodules and describe here the radiologic-pathologic correlations and surgical treatment. In 21 patients, lung cancer was suspected preoperatively, based on radiographic findings of an ill-defined margin, pleural indentation and spicular radiation.

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