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Tissue is issue: Not all masses are tumors

Varun R. Patel, Darsana Viswam, V. Rajesh, A. Nagrajan, K. Seema, Sethu Babu

Am J Case Rep 2012; 13:51-54

DOI: 10.12659/AJCR.882628


Background:    Tuberculosis can disguise itself in any form. Endobronchial tuberculosis usually presents in young adults. Endobronchial tumor-like presentation of tuberculosis (EBTB) is very rare and often mistaken as a malignancy. Diagnosis is usually delayed, as clinical and radiological features are non-specific. Direct implantation of tubercle bacilli into the bronchus, or an adjacent spread, leads to EBTB. Bronchoscopic biopsy and culture are the best modality for diagnosis.
    Care Reports:    We present a series of endobronchial tumor-like presentations of EBTB. Clinically and radiologically, they were similar in presentation to an endobronchial tumor. One of them had rib erosion on bone scan. Repeated bronchoscopic biopsies were non-conclusive and required more invasive procedures for diagnosis. All of them are diagnosed as endobronchial tuberculosis, either histopathology or by culture that grew mycobacterium tuberculosis, and were successfully treated with anti-tuberculous treatment alone, without residual scarring.
    Conclusions:    Tuberculosis should be considered in the differential diagnosis of endobronchial mass lesions in the correct clinical setting since this is an uncommon presentation for which invasive procedures are needed to establish the diagnosis. Initially, it was mistaken as a malignancy and there was delay in diagnosis and initiation of treatment. Prompt treatment is crucial to avert residual bronchostenosis.

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