Primary hepaticobiliary tuberculosis mimicking gall bladder carcinoma with liver invasion: a case report

Abstract

Primary hepatic tuberculosis is a rare presentation and sporadically reported in the literature, mostly from our part of the world. Sometimes the presentation can be atypical and mimics hepatic tumor and poses diagnostic challenge. We, herein, present a case of a 58-year-old man who presented to us with abdominal pain and weight loss. Raised serum alkaline phosphatase (ALP) and imaging raised a suspicion of gall bladder carcinoma with hepatic invasion. Peroperative frozen section revealed hepatic chronic granulomatous inflammation with caseous necrosis consistent with the diagnosis of hepatic tuberculosis. Surgery was postponed and he was put on antituberculous treatment. It is important to consider tuberculosis in the differential diagnosis of the space occupying lesion of liver in a patient with vague symptoms and abnormal findings on imaging.

Keywords: Carcinoma; frozen section; gall bladder; liver biopsy; tuberculosis.

Figure 1

Computerized tomographic (CT) images of the case: A) gall bladder showing diffusely thickened wall and irregularities at fundus; B) surrounding liver shows small area of hypodensity suggestive of gall bladder malignancy with liver metastasis

Figure 2

Histopathological images: A) low-power view showing two well-formed epithelioid granulomata with central necrosis (hematoxylin and eosin, ×100); B) medium-power view showing well-formed epithelioid granuloma with central caseation necrosis (hematoxylin and eosin, x 200)