Squamous Cell Carcinoma in the Post Tuberculosis Lung after 30 Years of Treatment Completion

Abstract

Pulmonary tuberculosis (TB) and lung cancer are becoming increasingly prevalent especially in developing countries. The occurrence of lung cancer after 30 years of completed pulmonary TB treatment is rare. We report a rare occurrence of a squamous cell carcinoma (SCC) in the post TB lung after 30 years of completed pulmonary tuberculosis treatment. A 60-year-old male, an apparently healthy nonsmoker, presented with a community-acquired Klebsiella pneumonia. Imaging revealed a destroyed left lung with cavities with air-fluid levels. An enhancing lesion was noted at the left upper lobe, and a guided biopsy revealed a SCC. He was fit for surgery and underwent an open left pneumonectomy. The left lung was destroyed and cavitatory due to the previous tuberculosis. A peripherally located tumor was noted in the left upper lobe. Histology revealed a moderately differentiated keratinizing type SCC (pT4N0Mx). The negative cultures and histology excluded an active pulmonary tuberculosis. The postsurgical lung function at 1 month showed satisfactory improvement with good functional capacity. He was then referred to the oncologist for adjuvant therapy. The occurrence of post-TB lung cancer after 30 years in an otherwise healthy male without active TB suggests an increased long-term risk of cancer even in the absence of other robust risk factors. Therefore, the chronic inflammatory process in the diseased lung is probably the cause for lung cancer in the absence of active TB. Thus, we suggest long-term surveillance after completed pulmonary TB treatment even in otherwise healthy asymptomatic individuals.