J Liver Cancer.  2023 Sep;23(2):397-401. 10.17998/jlc.2023.08.30.

A single hepatic mass with two tales: hepatic tuberculosis and hepatocellular carcinoma

• Koh YDI
• Leow WQ

• KMID: 2546419
• DOI: http://doi.org/10.17998/jlc.2023.08.30

Abstract

Hepatic tuberculosis (HTB) is an uncommon manifestation of tuberculous infections, and there has been no proven causal link between HTB and hepatocellular carcinoma (HCC). We herein present a rare case of a synchronous presentation of HTB and HCC within a single hepatic mass. A 57-year-old Chinese gentleman with recently diagnosed sigmoid adenocarcinoma was found to have a left lower lobe pulmonary nodule and solitary hepatic mass on staging computed tomography. Biopsies showed the hepatic mass to have both HTB and HCC components. This serves as a reminder that HTB is an important differential to consider for space-occupying lesions in the liver. Histological evaluation of suspected hepatic malignancies is recommended to exclude the presence of HTB in appropriate clinical settings.

Keyword

Tuberculosis; Tuberculosis; hepatic; Carcinoma; hepatocellular

Figure

• 

  Figure 1. Histology of pulmonary nodule. (A) H&E stain shows caseating granuloma at 200× magnification. (B) Identification of acid-fast bacilli (arrows) on ZN staining at 600× magnification. H&E, hematoxylin and eosin; ZN, Ziehl-Neelsen.

• 

  Figure 2. Core biopsy of hepatic nodule. (A) Core showing caseating granuloma (arrows) and area of HCC on low-powered view (40× magnification). (B) Caseating granuloma with surrounding multinucleated giant cells at 100× magnification. (C) Area with HCC at 100× magnification. (D) High-powered view (200× magnification) of HCC displaying pseudo-glandular architecture. (E) Positive staining for CD34 marker, indicating capillarization of sinusoids. (F) Patchy staining for glypican-3. HCC, hepatocellular carcinoma.

• 

  Figure 3. Sections of central hepatectomy specimen demonstrating tumor (arrows) with surrounding yellow necrotic nodules (arrowheads).

• 

  Figure 4. Histology of resected hepatic mass. (A) Caseating granulomas (bold arrows) located adjacent to area of HCC (thin arrow) at 20× magnification. (B) Area of HCC with positive CD34 staining (20× magnification). (C) Caseating granuloma (bold arrow) adjacent to area of HCC (thin arrow) staining positive for glypican-3 on high-powered view (100× magnification). (D) Caseating granuloma with surrounding multinucleated giant cells (arrowheads) and central area of necrosis at 100× magnification. HCC, hepatocellular carcinoma.

Reference

References

1. Akıcı M, Bozkurt E, Özdemir Ç, F Kaya. Primary hepatic tuberculosis mimicking malignancy. Int Surg J. 2019; 6:3078–3082.

2. Falagas ME, Kouranos VD, Athanassa Z, Kopterides P. Tuberculosis and malignancy. QJM. 2010; 103:461–487.

3. Tatco VR, Mejia-Santos MMA, Uy JAU. The many faces of hepatic tuberculosis. TB Corner. 2015; 1:1–6.

4. Levine C. Primary macronodular hepatic tuberculosis: US and CT appearances. Gastrointest Radiol. 1990; 15:307–309.

5. Limaiem F, Gargouri F, Bouraoui S, Lahmar A, Mzabi S. Co-existence of hepatocellular carcinoma and hepatic tuberculosis. Surg Infect (Larchmt). 2014; 15:437–440.

6. Shah D, P G, S S, Koushik AK. Synchronous presentation of tuberculosis and hepatocellular carcinoma in a cirrhotic patient: a case report. Trop Doct. 2020; 50:71–74.

7. Liao JR, Zhang D, Wu XL. Pulmonary tuberculosis combined with hepatic tuberculosis: a case report and literature review. Clin Respir J. 2015; 9:501–505.

8. Hickey AJ, Gounder L, Moosa MY, Drain PK. A systematic review of hepatic tuberculosis with considerations in human immunodeficiency virus co-infection. BMC Infect Dis. 2015; 15:209.

9. Zhang L, Yang NB, Ni SL, Zhang SN, Shen CB, Lu MQ. A case of multiple macronodular hepatic tuberculosis difficult to differentiate from hepatocellular carcinoma with intrahepatic metastasis: CTguided fine needle aspiration biopsy confirmed the diagnosis. Int J Clin Exp Pathol. 2014; 7:8240–8244.

10. Yang C, Liu X, Ling W, Song B, Liu F. Primary isolated hepatic tuberculosis mimicking small hepatocellular carcinoma: a case report. Medicine (Baltimore). 2020; 99:e22580.