Concomitant hepatic tuberculosis and hepatocellular carcinoma: a case report and review of the literature

Abstract

Background: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare.

Case presentation: We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis.

Conclusion: A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

Keywords: Case reports; Epatic tuberculosis; Hepatocellular carcinoma; Neoplasms.

Fig. 1

Contrast-enhanced abdominal computed tomography images acquired on initial presentation (a axial image in the arterial phase; b, c axial images in the venous phase; and d coronal image in the venous phase) demonstrating a heterogeneous mass (M) with internal hypodensity in segment V (a and b). Necrotic lymph nodes (thin arrows in c and d) and mild biliary dilatation (thick arrow in d) were noted

Fig. 2

Microscopic view (H&E stain, × 40) showed moderate-to-prominent cellular and nuclear pleomorphism and hyperchromatism along with frequent abnormal mitoses and apoptotic bodies (a). The immunohistochemistry view demonstrated the expression of alpha-fetoprotein (b). H&E, hematoxylin and eosin

Fig. 3

Contrast-enhanced abdominal computed tomography images acquired 1 month following the initial presentation (a axial image in the arterial phase; b, c axial images in the venous phase; and d coronal image in the venous phase) demonstrating an interval increase in the size of the mass lesion (M) with larger central hypodensities (a and b). Necrotic lymph nodes (thin arrows in c and d) were observed. A new nodule in the left liver lobe (thick arrow in c) and interval increase in the size of the nodule at the falciform ligament (arrow in a) were noted