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Medical Science Monitor Basic Research


The Presence of Coexisting Lung Cancer and Non-Tuberculous Mycobacterium in a Solitary Mass

Challenging differential diagnosis, Rare disease

Naohiro Taira, Hidenori Kawasaki, Sayako Takahara, Kenji Chibana, Eriko Atsumi, Tsutomu Kawabata

Japan Department of Surgery, National Hospital Organization, Okinawa National Hospital, Ginowan, Okinawa, Japan

Am J Case Rep 2018; 19:748-751

DOI: 10.12659/AJCR.908090

Available online: 2018-06-26

Published: 2018-06-26


BACKGROUND: Whereas non-tuberculous mycobacterium (NTM) pulmonary disease can mimic lung cancer as a solitary pulmonary nodule or mass, the coexistence of lung cancer and NTM pulmonary disease in a single nodule or mass is rare. We report such a rare case, highlighting that during a bronchoscopes examination which comprises taking a transbronchial lung biopsy (TBLB), bronchial brushing, and bronchial lavage, a positive mycobacterium culture result for sputum or bronchial lavage fluid does not exclude the possibility of a concomitant lung cancer.
CASE REPORT: An 87-year-old male was referred to our institution for evaluation of an abnormal shadow on a chest x-ray scan. He had been previously healthy with no symptoms and an unremarkable medical history. A contrast-enhanced CT scan showed a cavitating mass measuring 20×40 mm with a thick ring-enhancing irregular wall in the left lower lobe. Although the TBLB of the lesion showed no malignant cells, sputum acid-fast bacilli smear and culture of the bronchial lavage fluid yielded positive results. An NTM infection, instead of lung cancer was suspected to have caused the mass because a Mycobacterium tuberculosis polymerase chain reaction showed negative results. However, we performed the surgery because NTM pulmonary disease and lung cancer cannot be differentiated. The results of a pathological examination of the mass showed an adenocarcinoma, and M. avium complex was detected in the cancer tissue culture.
CONCLUSIONS: Physicians should suspect the co-existent lung cancer and NTM infection in patients with solitary lung masses that yield a positive mycobacterium culture result for sputum or bronchial lavage fluid.

Keywords: Biopsy, Lung Neoplasms, Mycobacterium Infections, Nontuberculous