Liver hilar tuberculous lymphadenitis successfully diagnosed by laparoscopic lymph node biopsy

Abstract

Liver hilar tuberculous lymphadenitis is extremely rare. A case of liver hilar tuberculous lymphadenitis mimicking lymph node metastasis of anal canal cancer that was successfully diagnosed by laparoscopic lymph node biopsy is reported. A 49-year-old man with a past medical history of pulmonary tuberculosis suffering from anal canal cancer with left inguinal lymph node metastasis underwent laparoscopic anterior perineal resection and left inguinal lymph node dissection in February 2010. Subsequently, he underwent dissection of right inguinal lymph node metastases from anal canal cancer twice in February and October 2013. In July 2014, follow-up computed tomography (CT) showed a 26mm×23mm lesion with calcification on the anterior side of the portal vein in the hepatoduodenal ligament. He had no jaundice. Positron emission tomography with 2[18 F]-fluoro-2-deoxy-d-glucose (FDG-PET) revealed a mass with high uptake. Suspecting a lymph node metastasis from anal canal cancer, laparoscopic lymph node biopsy was performed. Histopathological and polymerase chain reaction (PCR) examinations yielded a diagnosis of tuberculous lymphadenitis. No evidence of recurrence of cancer has been seen during the 5 years of follow-up after the surgery for anal canal cancer. FDG-PET imaging is rarely useful for differentiating cancer from tuberculosis lesions. Laparoscopic lymph node biopsy is a safe, effective alternative to open surgical biopsy. Tuberculous lymphadenitis should be included among the differential diagnoses of liver hilar lymphadenopathy in patients with a history of tuberculous. Laparoscopic lymph node biopsy is useful for the diagnosis of undiagnosed lymphadenopathy.