Hepatic tuberculoma mimicking hepatocellular carcinoma in an immunocompetent host

Abstract

Hepatic tuberculosis as a part of disseminated tuberculosis is seen in 50-80% of cases. Isolated hepatic tuberculosis is very uncommon even in countries with high prevalence of tuberculosis. It can occur as a primary case or due to reactivation of an old tubercular focus. We report a case of a 59-year-old Caucasian woman who presented with persistent right upper quadrant pain and a hepatic lesion on an abdominal CT. She had a history of pulmonary tuberculosis 15 years ago with localised lung tuberculosis treated with lobectomy and antituberculous drugs.

Figure 1

(A) Non-contrast-enhanced CT of the abdomen demonstrates a 2.7 cm hypodense focal lesion in segment VII of the liver (arrow). (B) After the intravenous administration of iodinated contrast the lesion showing moderate enhancement in the arterial phase. (C) In the portal-vein phase there is contrast wash out with peripheral capsular enhancement.

Figure 2

(A) The presence of centrally necrotic granuloma (caseation) in liver parenchyma (H&E, ×10). (B) The presence of centrally necrotic granuloma (caseation) in liver parenchyma (H&E, ×20). (C) Granuloma with multinucleated giant cell (H&E, ×40).