Korean Journal of Pediatrics 2009;52(8):904-909.
Published online August 15, 2009.
Pulmonary tuberculosis misdiagnosed as lung Metastasis in childhood cancer patients
Hyun Rae KK1, Dong Whand Lim1, Kang Min1, Kyung Duk Park1, Jun Ah Lee1, Soo Yeon Cho3, Yoon Hoh Kook4, Hee Youn Kim4, Dong Ho Kim2
1Department of Pediatrics, Korea Cancer Center Hospital Seoul
2Department of Pediatrics, Korea Cancer Center Hospital Seoul, Korea
3Department of Pathology, Korea Cancer Center Hospital Seoul, Korea
4Department of Microbiology, Seoul University School of Medicine, Seoul, Korea
소아암 환자에서 암의 전이로 오인된 폐결핵
이현재1, 김동환1, 이강민1, 박경덕1, 이준아1, 조수연3, 국윤호4, 김희연4, 김동호2
1원자력병원 소아청소년과
2원자력병원 소아청소년과
3원자력병원 해부병리과
4서울대학병원 미생물학과
Correspondence: 
Dong Ho Kim, Email: kdh281929@gmail.com
Abstract
Purpose
The differential diagnosis for a pulmonary nodule is intriguing in cancer patients. Metastasis might be a preferential diagnosis, and yet possibilities of other medical conditions still exist. Pulmonary tuberculosis should be enlisted in the differential diagnosis for a pulmonary nodule in cancer patients in Korea. This study was aimed at analyzing the incidence and clinical features of pulmonary tuberculosis that were misdiagnosed as pulmonary metastasis during radiologic follow-up in pediatric cancer patients.
Methods
We retrospectively studied 422 cancer patients less than 18 years old in the Korea Cancer Center Hospital from January 2001 to June 2007. We collected episodes of lung metastasis of primary tumor and tuberculosis during treatment or follow-up, and analyzed medical records.
Results
There were 5 cases of tuberculosis confirmed after surgery which were initially regarded as cancer. Two patients had respiratory symptoms such as cough and sputum but the other 3 patients did not. One patient had a family history of tuberculosis. Acid-fast M. tuberculosis was found in one case upon tissue specimen analysis. Two cases were Mantoux positive and the sputum examination was negative in all cases. The polymerase chain reaction for tuberculosis on a pathologic specimen was used to differentiate M. tuberculosis from non-tuberculosis mycobacterium (NTM). It was positive in one case. Lung lesions in one case showed a concurrence of tuberculosis along with lung metastasis. One of these patients died after cancer recurrence.
Conclusion
It is necessary to consider the possibility of tuberculosis when a lung mass is newly detected during treatment or follow-up in patients with childhood cancer.
Key Words: Tuberculosis, Pulmonary, Bone and Soft tissue sarcoma, Pulmonary metastasis


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