Factor Patricia Ann A, Toral Jean Anne B, Bravo Sybill Lizanne R
Division of Family Planning and Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Philippine General Hospital, University of the Philippines Manila.
Acta Med Philipp. 2024 Jun 28;58(11):99-102. doi: 10.47895/amp.v58i11.8011. eCollection 2024.
Tuberculosis can coexist with malignancy in the same organ, but cancer with TB in the cervix is rare. This is a case of cervical tuberculosis diagnosed in a cervical cancer patient after concurrent chemoradiotherapy and brachytherapy. This is the case of a 38-year-old G2P2 (2002) diagnosed with squamous cell carcinoma, large cell non-keratinizing cervix, Stage IIIB. The patient underwent concurrent chemoradiotherapy and brachytherapy. One month after the last brachytherapy dose, the attending physician noted a nodularity on the anterior lip of the cervix. A cervical punch biopsy was done to rule out tumor persistence. The histopathology revealed chronic granulomatous inflammation with Langhan's type multinucleated giant cells consistent with tuberculous infection. She was diagnosed with cervical tuberculosis, postulated to be from latent TB reactivation, and was given Anti-Koch's medication for six months. After receiving Anti-Koch's treatment, the cervical nodularity was no longer appreciated, and the rest of the cervix was smooth on palpation. Her Pap Test was negative for any intraepithelial lesion and was declared with no evidence of carcinoma. A possible latent TB infection should always be screened in cancer patients from high-burden areas or those with close contact treated for tuberculosis because immunosuppression during cancer treatment can cause the reactivation of tuberculous disease. Cervical tuberculosis complicating cervical malignancy is treatable with Anti-Koch's therapy and has not been shown to affect the course of the carcinoma.
结核病可与同一器官的恶性肿瘤共存，但宫颈癌合并结核较为罕见。本文报告一例宫颈癌患者在同步放化疗及近距离放疗后诊断为宫颈结核的病例。患者为38岁经产妇（孕2产2，末次分娩时间2002年），诊断为宫颈鳞状细胞癌，大细胞非角化型，ⅢB期。患者接受了同步放化疗及近距离放疗。在最后一次近距离放疗剂量后1个月，主治医生注意到宫颈前唇有结节。进行了宫颈穿刺活检以排除肿瘤残留。组织病理学显示慢性肉芽肿性炎症，伴有朗汉斯型多核巨细胞，符合结核感染。她被诊断为宫颈结核，推测为潜伏性结核再激活，给予抗痨药物治疗6个月。接受抗痨治疗后，宫颈结节消失，触诊宫颈其余部位光滑。她的巴氏试验结果显示无上皮内病变，且未发现癌证据。对于来自高负担地区的癌症患者或有结核密切接触史且接受过治疗的患者，应始终筛查是否存在潜在的结核感染，因为癌症治疗期间的免疫抑制可导致结核疾病再激活。宫颈结核合并宫颈恶性肿瘤可用抗痨治疗，且未显示会影响癌症病程。
