Abstract
To find a clue for solving difficulties in differential diagnosis between lung cancer and pulmonary tuberculoma, 32 tuberculomas diagnosed by exploratory excision during the last 9 years were analysed from clinical, bacteriological and pathological standpoint.
The sex was male in 23 patients and female in 9. The average age was 53.5 years old.
The lesion was found by mass-survey in 14, during the treatment of other diseases in 11, meanwhile by subjective symptoms in only 7 (21.9%).
Rentgenological size of the tuberculoma was between 0.9 and 4.0cm in diameter; the average diameter was 2.25cm. Rentgenological findings reveled a sharply demarcated margine in 84.4%, a lack of satelite lesions in 81.3%, indentation of the visceral pleura in 31.3%, notching in 25.0%, spicula in 9.4%, cavitation in 9.4%, and calcification in 12.5%. One or more rentgenological signs which were indicative of either malignant or benign tumor, such as notch, indentation of the visceral pleura, spicula, and a lack of satelite lesion, were seen in most of the cases.
Concerning preoperative diagnosis, 18 out of 32 cases were strongly suspected of lung cancer, because of false positive of cancer cells by sputum or biopsy, growing tendency of the shadow, positive result of 197H g scintigraphy and rentgenological signs. The other 8 out of 32 cases had a slight suspecion of lung cancer, and the remaining 6 cases were diagnosed as benign tumor rather than lung cancer mainly by rentgenological findings.
Tubercle bacilli in the resected specimens were examined in 29 out of 32 cases, and it was positive in only 15 cases (51.7%). This result suggests that there is a limitation in making preoperative diagnosis of tuberculoma by demonstrating tubercle bacilli.
Lobectomy was performed in 14 cases, 13 of which were strongly suspected of lung cancer and one was suspected of benign tumor. Segmentectomy was performed in 2, and partial resection in 16. Looking back, however, partial resection was more suitable in most of the cases which underwent lobectomy. Partial resection followed by frozen section examination should be the standard technique for exploration, because of less complications.
It is our policy to do exploratory excision positively in the patients who could not be proved, but not be denied, to have a lung cancer by routine diagnostic methods. On the other hand, in case tuberculoma is strongly suspected by routine examinations, diagnostic anti-tuberculosis chemotherapy is also indicated rather then exploratory thoracotomy. The duration of diagnostic antituberculosis chemotherapy should not be longer than two months before it is re-discussed whether its diagnosis is correct or not.
