Transcript Pulmonary Tuberculosis and Lung Cancer

Pulmonary Tuberculosis
and Lung Cancer
Diagnosis of Primary Tumor
 Sputum
Cytology
 Flexible Bronchoscopy and Biopsy
 TTNA transthoracic needle aspiration
 Cell Type Accuracy
 Central
lesion, bronchoscopy is the
most sensitive way to confirm a
diagnosis of cancer.
 Small (ie, < 2 cm) peripheral lesion, the
sensitivity of bronchoscopy is low. TTNA
has a much higher sensitivity than
bronchoscopy
Difficult to differential diagnosis
 The
diagnosis of lung cancer
superimposed on pulmonary
tuberculosis is difficult especial the Acid
fast stain is positive.
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Thorac Med 120-7 vol.17 no2 2002
Indian Journal of Chest Diseases & Allied
Sciences. 39(4):251-4, 1997 Oct-Dec.
 In
the endemic area of tuberculosis,
there are many cases that present
tuberculosis as a solitary pulmonary
nodule (SPN) on chest radiographs.
hardly to D.D from lung cancer
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Respiratory Medicine. 90(3):139-43, 1996 Mar.
 The
possibility of coexisting tuberculosis
should be kept in mind in patients
with a malignancy, especially those with
lung carcinoma in countries with a high
prevalence of tuberculosis
Tumori. 88(3):251-4, 2002 May-Jun
Folia Histochemica et Cytobiologica. 39 Suppl 2:73-4, 2001
Incidence
 The
incidence of lung cancer in
tuberculosis patients was about 2%.
 Both lung cancer and pulmonary
tuberculosis have a higher incidence of
upper lober involvement.
Thorac Med 2002 17:120-127
 The
incidence of lung cancer is
higher in patients with pulmonary
tuberculosis (TB).
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Japanese Journal of Clinical Oncology. 26(5):322-7, 1996
Oct
Thorac Med 120-7 vol.17 no2 2002
Southern Medical Association Journal. 81(3):337-40, 1988
Mar.
The risk factors of lung cancer
 Cigarette
smoking,
 Occupations,
 Previous tuberculosis history
found to independently correlate with an
elevated risk of lung cancer for
male patients.
Cancer Causes & Control.12(4):289-300, 2001 May)
TB scar v.s Lung Cancer
 Significant
association between
tuberculous scars and carcinoma of the
lung.
 The possibility of malignancy has to be
kept in mind when radiological
scanning reveal the presence of lung
scars.
 European Journal of Radiology. 7(3):163-4, 1987 Aug.
The Marker - BAL neopterin
 BAL neopterin
levels are elevated in
patients with lung cancer, especially
the small-cell carcinoma type.
 The levels of neopterin in BAL
fluid may reflect the degree of disease
activity in pulmonary tuberculous
patients.
 Derived
from guanosine triphosphate
 Produced by stimulated macrophages
under the influence of gamma-interferon
of lymphocyte origin.
 An excellent marker for the activation of
the monocyte/macrophage.
Serum adenosine deaminase
 The
mean (+/- SD) of ADA activity was
23.38 (4.47), 7.29 (1.08), 12.71 (1.95)
and 2.23 (1.00) units/litre in
tuberculosis,
malignancy, non-tubercular pulmonary
diseases and healthy controls.
Serum C-reactive protein
 Tuberculous
patients with cavitation in
chest X-ray had significantly higher
levels of CRP than those without as well
as healthy controls.
 Normal CRP did not exclude
tuberculosis
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Infection. 17(1):13-4, 1989 Jan-Feb
Reactivation of tuberculosis
 Deterioration
of immunity due to local or
systemic effects of the tumor itself
and/or administered chemotherapeutics
or radiotherapy may play roles
increasing the mortality in patients
with various malignancies
Tumori. 88(3):251-4, 2002 May-Jun
Evaluation methods
 Direct
microscopic evaluation
 Sputum specimens
 Materials obtained by fiberoptic
bronchoscopy should be cultivated for
tuberculosis.
Differential Diagnosis Tools
MR imaging is a helpful
adjunctive method in terms of
differentiating a tuberculoma from a
malignant tumor
Journal of Magnetic Resonance Imaging. 11(6):629-37, 2000
Jun
Differential Diagnosis Tools
 Diagnostic
bronchoscopy under
fluoroscopic guidance is a useful tool in
evaluation of patients with a peripheral
pulmonary nodule
Minimize unnecessary thoracotomy and
give way for proper medication as early
as possible.
Differential Diagnosis Tools
 FDG-PET
can identify malignant
pulmonary lesions both in patients
without and with a history of prior
malignancy with a high sensitivity and
negative predictive value for lesions
greater than 1 cm.
Differential Diagnosis Tools
 Differentiating
tuberculosis or
mycobacteriosis from bronchogenic
carcinoma, metastasis, or pneumonia
was difficult and biopsy was often
necessary.
Differential Diagnosis Tools
 Combined
assays of CEA, CA 19-9, and
ADA may be useful in distinguishing
pleural effusions due to malignancies
from those of tuberculous origin
Treatment
 Three-four-drug
anti-tuberculosis
regimens should be given, especially in
countries with high drug-resistance
rates for eradicating tuberculosis.
Treatment
 Surgery
treatment of clinical patterns of
pulmonary tubercolosis unresponsive to
medical treatment
May be underlying lung cancer
 Survival
is shorter in lung cancer
patients who present initially with active
TB than in those who do not have TB.
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Japanese Journal of Clinical Oncology. 26(5):322-7, 1996
Oct.