Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Pulmonary tuberculosis misdiagnosed as lung Metastasis in childhood cancer patients

소아암 환자에서 암의 전이로 오인된 폐결핵

  • Lee, Hyun-Jae (Department of Pediatrics, Korea Cancer Center Hospital Seoul) ;
  • Kim, Dong-Whan (Department of Pediatrics, Korea Cancer Center Hospital Seoul) ;
  • Lee, Kang-Min (Department of Pediatrics, Korea Cancer Center Hospital Seoul) ;
  • Park, Kyung-Duk (Department of Pediatrics, Korea Cancer Center Hospital Seoul) ;
  • Lee, Jun-Ah (Department of Pediatrics, Korea Cancer Center Hospital Seoul) ;
  • Cho, Soo-Yeon (Department of Pathology, Korea Cancer Center Hospital Seoul) ;
  • Kook, Yoon-Hoh (Department of Microbiology, Seoul University School of Medicine) ;
  • Kim, Hee-Youn (Department of Microbiology, Seoul University School of Medicine) ;
  • Kim, Dong-Ho (Department of Pediatrics, Korea Cancer Center Hospital Seoul)
  • 이현재 (원자력병원 소아청소년과) ;
  • 김동환 (원자력병원 소아청소년과) ;
  • 이강민 (원자력병원 소아청소년과) ;
  • 박경덕 (원자력병원 소아청소년과) ;
  • 이준아 (원자력병원 소아청소년과) ;
  • 조수연 (원자력병원 해부병리과) ;
  • 국윤호 (서울대학병원 미생물학과) ;
  • 김희연 (서울대학병원 미생물학과) ;
  • 김동호 (원자력병원 소아청소년과)
  • Received : 2009.04.13
  • Accepted : 2009.07.27
  • Published : 2009.08.15
Download PDF
⟨ Previous Next ⟩

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.

목적 : 암환자들은 암의 재발여부를 추적관찰 하기 위해 다양한 영상검사들을 시행하고 있다. 이러한 환자들의 흉부 방사선 추적검사에서 결절이 발견되는 경우에는 종양의 폐전이를 의심하는 것이 일반적이다. 그러나 다른 질환, 특히 우리나라에서 유병률이 높은 폐결핵도 감별해야 한다. 본 연구는 소아암 환자의 흉부 방사선 추적검사 도중 암의 전이로 오인된 폐결핵의 빈도와 그 임상양상을 분석하고자 하였다. 방법 : 2001년 1월부터 2007년 6월까지 원자력병원에서 암으로 진단된 18세 이하의 소아 환자 422명을 대상으로 하였고, 후향적으로 의무기록을 고찰하여 치료 과정 및 치료종결 후 추적관찰 중 암의 폐전이와 폐결핵이 발병한 경우를 찾아내어 그 임상 양상을 분석하였다. 결과 : 수술 후 암으로 오인된 폐결핵은 5례였다. 이들 5명 환자에서 2명은 기침과 가래 등의 호흡기 증상이 있었으며, 나머지는 특별한 소견이 보이지 않았다. 5명 모두 열, 체중 감소, 쇠약감 등의 전신증상은 관찰되지 않았다. 가족 내 결핵의 가족력을 가지고 있었던 경우는 1례 였고, 조직 항산성 염색을 시행하였는데, 이 중 1례가 결핵균 양성으로 드러났고 나머지 4례는 음성이었다. 결핵 피부반응검사 상 양성으로 나온 경우는 2례였으나 객담 검사는 모두 음성이었다. 비정형결핵과의 감별을 위하여 환자들의 폐병변 조직을 얻었으며 이것으로 Tb PCR 시행한 결과, 1례에서 양성소견이 관찰되었다. 5례 중 4례는 폐병변이 모두 폐결핵으로만 드러났으나 1 례는 특이하게도 폐결핵과 폐 전이가 병발하였다. 이 환자는 이후 종양이 재발해 사망하였다. 결론 : 소아암의 기저질환을 가지고 있었던 환자에 있어서 치료 과정 중 또는 추적 관찰 중 새로이 발견된 폐의 종괴를 진단할 때는 결핵의 가능성도 고려하여야 한다.

Keywords

References

  1. Estimated Tb incidence, prevalence and mortality, 2005. Available at: http://www.who.int/mediacentre/factsheets/fs104/ en/index.html. accessed January 12, 2009
  2. Feja K, Saiman L. Tuberculosis in children. Clin Chest Med 2005;26:295-312 https://doi.org/10.1016/j.ccm.2005.02.010
  3. Nair N. Childhood tuberculosis: public health and contact tracing. Paediatr Respir Rev 2001;2:97-102 https://doi.org/10.1053/prrv.2000.0116
  4. New tuberculosis case notification rate per 100,000 by sex and age, 2003. Available at : http://www.knta.or.kr/english/ statistics/statistics01.asp. accessed January 12, 2009
  5. Wang T, Ren H, Li Z, Zhang Z, Sun C, Xu L. Misdiagnosis of lung cancer in patients under age 40--a clinical analysis of 47 cases. Chin Med Sci J 1993;8:95-7
  6. Sakuraba M, Hirama M, Hebisawa A, Sagara Y, Tamura A, Komatsu H. Coexistent lung carcinoma and active pulmonary tuberculosis in the same lobe. Ann Thorac Cardiovasc Surg 2006;12:53-5
  7. Ashizawa K, Matsuyama N, Okimoto T, Hayashi H, Takahashi T, Oka T, et al. Coexistence of lung cancer and tuberculoma in the same lesion: demonstration by high resolution and contrast-enhanced dynamic CT. Br J Radiol 2004;77: 959-62 https://doi.org/10.1259/bjr/31864795
  8. Lee JG, Kim DJ, Shin KH, Park IK, Chung KY, Song SJ. Repeated pulmonary metastasectomy in patients with osteosarcoma. Korean J Thorac Cardiovasc Surg 2007;40:607-12
  9. Su WT, Chewning J, Abramson S, Rosen N, Gholizadeh M, Healey J, et al. Surgical management and outcome of osteosarcoma patients with unilateral pulmonary metastases. J Pediatr Surg 2005;39:418-23 https://doi.org/10.1016/j.jpedsurg.2003.11.030
  10. Tsuchiya H, Kanazawa Y, Abdel-Wanis ME, Asada N, Abe S, Isu K, et al. Effect of timing of pulmonary metastases identification on prognosis of patients with osteosarcoma: the Japanese Musculoskeletal Oncology Group study. J Clin Oncol 2002;20:3470-7 https://doi.org/10.1200/JCO.2002.11.028
  11. Robertson PL, Boldt DW, De Campo JF. Paediatric pulmonary nodules: a comparison of computed tomography, thoracotomy findings and histology. Clin Radiol 1988;39:607-10 https://doi.org/10.1016/S0009-9260(88)80062-X
  12. Lillington GA, Caskey CI. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med 1993;14:111-9
  13. Saulat H. Fatimi. Solitary Pulmonary Nodule. Medicine Today 2006;4;88-91
  14. Midthun DE, Swensen SJ, Jett JR. Clinical strategies for solitary pulmonary nodule. Annu Rev Med 1992;43:195-208 https://doi.org/10.1146/annurev.me.43.020192.001211
  15. Ginsberg MS, Griff SK, Go BD, Yoo HH, Schwartz LH, Panicek DM. Pulmonary nodules resected at video-assisted thoracoscopic surgery: etiology in 426 patients. Radiology 1999;213:277-82
  16. Duhaylongsod FG, Lowe VJ, Patz EF Jr, Vaughn AL, Coleman RE, Wolfe WG. Detection of primary and recurrent lung cancer by means of F-18 fluorodeoxyglucose positron emission tomography (FDG PET). J Thorac Cardiovasc Surg 1995;110:130-9 https://doi.org/10.1016/S0022-5223(05)80018-2
  17. Cohen M, Smith WL, Weetman R, Provisor A. Pulmonary pseudometastases in children with malignant tumors. Radiology 1981;141:371-4
  18. Hara T, Kosaka N, Suzuki T, Kudo K, Niino H. Uptake rates of 18F-fluorodeoxyglucose and 11C-choline in lung cancer and pulmonary tuberculosis: a positron emission tomography study. Chest 2003;124:893-901 https://doi.org/10.1378/chest.124.3.893
  19. Knight SB, Delbeke D, Stewart JR, Sandler MP. Evaluation of pulmonary lesions with FDG-PET. Comparison of findings in patients with and without a history of prior malignancy. Chest 1996;109:982-8 https://doi.org/10.1378/chest.109.4.982
  20. Goo JM, Im JG, Do KH, Yeo JS, Seo JB, Kim HY, et al. Pulmonary tuberculoma evaluated by means of FDG PET: findings in 10 cases. Radiology 2000;216:117-21
  21. Kim BJ, Hong SK, Lee KH, Yun YJ, Kim EC, Park YG, et al. Differential Identification of Mycobacterium tuberculosis Complex and Nontuberculous Mycobacteria by Duplex PCR Assay Using the RNA Polymerase Gene (rpoB). J Clin Microbiol. 2004:42:1308-12 https://doi.org/10.1128/JCM.42.3.1308-1312.2004
  22. Hong YP, Kim SJ, Lew WJ, Lee EK, Han YC. The seventh nationwide tuberculosis prevalence survey in Korea, 1995. Int J Tuberc Lung Dis 1998;2:27-36