We analyzed clinicopathological data on 11 cases in which
lung cancer and active pulmonary mycobacteriosis are intermingled in the same lung lobe out of 61 admitted cases of coexisting
lung cancer and active pulmonary mycobacteriosis, encountered at National Hospital Organization Tokyo National Hospital during the period from 1991 to 2003.
RESULTS: The subjects were 10 men and 1 woman, with a mean age of 68 years. The species of mycobacteriosis were M.
tuberculosis in 6 and nontuberculous mycobacteriosis in 5 (M. avium disease and M. abscessus disease in 2 each, and M. kansasii disease in 1). The frequency of the mixture was 13% (6/45) in patients with
lung cancer and
tuberculosis and was 31% (5/16) in patients with
lung cancer and nontuberculous mycobacteriosis. Radiographic findings revealed that both
cancer shadows and mycobacteriosis shadows are identified in 8 of the 11 patients, whereas
cancer shadows were recognized but mycobacteriosis shadows could not be pointed out in the remaining 3 patients. We divided 7 cases (5 resection scases and 2 autopsy cases) with the mixture of
cancer and mycobacteriosis into 2 types from the macroscopic images: (1) type A (4 cases, the foci of
lung cancer and
tuberculosis, which were separated originally, progressed mutually, and has adjoined), and (2) type
B (2 cases, the foci of mycobacteriosis existed within or in the edge of the foci of
lung cancer). There were 3 nontuberculous mycobacteriosis cases and 1
tuberculosis case in type A, and 2
tuberculosis cases and 1 nontuberculous mycobacteriosis in type B. In nontuberculous mycobacteriosis cases,
cancer and mycobacteriosis had often adjoined under the conditions of preexisting
lung disease, such as a lung
cyst, whereas in
tuberculosis cases, it was characteristically shown that the wall of encapsulated caseous nodules was destroyed by
cancer invasion, and that the tuberculous nodules were reactivated. These findings seemed to be related to exogenous
infection of nontuberculous mycobacteriosis to the injured lungs and to endogenous reactivation of
tuberculosis from inactive tuberculous lesions.
CONCLUSION:
Lung cancer and active pulmonary mycobacteriosis are often seen intermingled in the same lung lobe, and the mixture pictures of the two diseases are variable. The physicians should carefully note about the mixture of
lung cancer and mycobacteriosis, though the findings are not clear on the chest plain radiographs.