Ahmad Basel, Durra Suzana, Tayfour Sabine, Habka Sandra, Albatal Bassel, Ahmad Mohamad
Department of General Surgery.
Faculty of Medicine, Damascus University.
Ann Med Surg (Lond). 2024 Mar 19;86(5):3056-3059. doi: 10.1097/MS9.0000000000001927. eCollection 2024 May.
Tuberculosis (TB) has been one of the most devastating diseases to humanity in recent decades; although pulmonary infection is the most common, infection of any other organ is familiar as well. Colon cancer is another disease affecting the gastrointestinal (GI) system and mostly targets people over 50. Only a few studies mentioned the co-existence of cancer and TB occurring at the same place and time. Hence, the authors report a rare case of concurrent ascending colon adenocarcinoma and colonic TB.
A 49 -year-old man presented to our clinic with constipation and abdominal pain. Two colonoscopies were performed, and two biopsies were taken; the first one showed granulomatous inflammation consistent with TB, and the second one showed low-grade adenocarcinoma. Computed tomography showed annular thickening of the ascending colon with infiltrates around the lesions. A right hemicolectomy was performed, and the final pathology confirmed adenocarcinoma grade II and extensive TB granulomas involving the colon into the serosa and the lymph nodes. Anti-TB medications were administered after surgery.
Due to appropriate diagnostic methods, TB and cancer were detected at an early stage. In our treatment protocol, no adjuvant chemotherapy was applied after surgery due to the possibility of drug interaction with anti-TB medications.
The two diseases may co-exist; thus, diagnosing them may not be the easiest, not to mention the lack of a clear treatment protocol in case of their accompany.
近几十年来，结核病一直是对人类最具毁灭性的疾病之一；尽管肺部感染最为常见，但其他任何器官的感染也并不罕见。结肠癌是另一种影响胃肠（GI）系统的疾病，主要影响50岁以上的人群。仅有少数研究提及癌症与结核病在同一部位和时间同时存在的情况。因此，作者报告了一例罕见的升结肠腺癌与结肠结核并存的病例。
一名49岁男性因便秘和腹痛前来我院就诊。进行了两次结肠镜检查并取了两次活检；第一次显示符合结核病的肉芽肿性炎症，第二次显示低级别腺癌。计算机断层扫描显示升结肠环形增厚，病变周围有浸润。行右半结肠切除术，最终病理证实为II级腺癌以及广泛的结核肉芽肿累及结肠至浆膜层和淋巴结。术后给予抗结核药物治疗。
由于采用了适当的诊断方法，结核病和癌症得以早期发现。在我们的治疗方案中，由于存在与抗结核药物发生药物相互作用的可能性，术后未应用辅助化疗。
这两种疾病可能并存；因此，诊断它们并非易事，更不用说在它们同时存在的情况下缺乏明确的治疗方案。
