Coexistence of Carcinoma and Tuberculosis in the Cecum: A Clinical Conundrum

Abstract

The coexistence of carcinoma of the colon and tuberculosis (TB) represents a rare and intricate clinical scenario. It poses significant challenges in both diagnosis and management. Clinical prediction of this coexistence is challenging since the clinical features of these two conditions are often similar. Likewise, the radiology is not decisive because of the significant overlap in the image findings of carcinoma and TB. A conclusive diagnosis relies on histopathological evidence of both malignancy and TB. Here, we report a case of a 58-year-old female who presented with chronic abdominal pain. Computed tomography showed the presence of a mass in the cecum. Histopathology of tissue retrieved through colonoscopy was indicative of features of both TB and adenocarcinoma of the cecum. Mycobacterium tuberculosis was detected in the tissue by cartridge-based nucleic acid amplification test. The patient was initiated on antitubercular treatment. She underwent surgical resection of the mass and is planned for adjuvant chemotherapy.

Keywords: abdominal tuberculosis; carcinoma cecum; coexisting tuberculosis and carcinoma; colon cancer; intestinal tuberculosis.

Figure 1. Histopathology of cecal mass biopsy (hematoxylin and eosin stained) showing pleomorphic tumor cells arranged in acinar configuration, cords, and trabeculae. There is moderate nuclear atypia and signet ring cell differentiation (blue arrows).

Figure 2. Histopathology of cecal mass biopsy (hematoxylin and eosin stained) showing infiltration of lymphocytes (green arrow) and epithelioid cells (yellow arrow) with the formation of a focus of poorly formed granuloma.