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Carcinoma colon with tuberculosis.
Both tuberculosis and carcinoma of the bowel are fairly common conditions but the sites of predilection for the two differ, namely tuberculosis is common in the ileum while carcinoma is in the large bowel. A few reports of both diseases occurring simultaneously are on record,[1] [3] but co-existence of the two at the same site is very rare. This prompted us to report this case.
A 65 year old female patient was admitted with complaints of distension of abdomen, vomiting and constipation for 3 days and history of similar complaints off and on for 3 months. On examination, there was a mass in the right iliac fossa with signs of intestinal obstruction. Investigations:-X-ray chest showed emphysema. Operative findings:-A large growth was seen in the caecum and the ascending colon. Ileocaecal opening was free. Right hemicolectomy was done. Peritoneal seedlings were seen. Patient expired 5 days after operation. Specimen [Fig. 1] received was of right hemicolectomy. The ileum was dilated. The ileocaecal opening was normal. There was no tuberculous lesion in the ileum. A stricture was present in the proximal part of ascending colon which measured about 10 cm in length. The wall was thickened and fibrotic. The mucosa showed ulceration. The serosal surface revealed fine miliary tubercles. The mesenteric nodes were enlarged and showed grey white cut surface with area of caseation. Histopathological examination showed ulceration with adenocarcinoma infiltrating through the full thickness of the colonic wall [Fig. 2]. Tubercles with focal caseation were also seen in the base and edge of the ulcer. The mesenteric node also revealed tuberculosis and metastatic carcinoma.
Tuberculosis of colon forms only 3 to 4% of intestinal tuberculosis. Tuberculosis of the colon tends to be segmental and obstructive symptoms dominate. Intestinal tuberculosis commonly occurs in the 2nd and the 3rd decades. Only 2% of cases present above the age of 60 years. Carcinoma may complicate tuberculosis. In a series of 87 cases of intestinal tuberculosis one was ileocaecal tuberculosis with adenocarcinoma in the adjacent area of the ascending colon.[2] Paustian[5] has reviewed 30 cases of carcinoma complicating tuberculosis of intestine; of these 18 were located in the caecum, 1 in the splenic flexure, 6 in the sigmoid colon and 5 were in the rectum. Though chronic diseases like ulcerative colitis, Crohn's disease and schistosomiasis are known[4] to predispose malignancy there is no evidence to indicate hlgher incidence of carcinoma colon in tuberculosis. One view is that carcinoma may facilitate entry of tubercle bacilli with development of secondary infection. This appears to be true in our case considering the uncommon age and site for tuberculosis.
The authors wish to thank the Dean, Seth G.S. Medical College and K.E.M. Hospital for permission to report this case.
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