Coexistence of Tuberculosis and Metastatic Undifferentiated Carcinoma of Nasopharynx in Cervical Lymph Node

Sameh Mezri, Sameh Sayhi, Marwa Ben Amira, Issam Msakni, Besma Laabidi, Rania Ben M'hamed, Khemaies Akkeri

ENT Department, Military Hospital of Tunis, Montfleury 1008,TunisiaTunisia
Internal Department of Medicine, Military Hospital of Tunis, Montfleury 1008,TunisiaTunisia
Anatomopathology Department, Military Hospital of Tunis, Montfleury 1008,TunisiaTunisia

DOI: https://doi.org/10.17140/otloj-5-156 · Published 2019-06-28 · Licence: https://creativecommons.org/licenses/by/4.0 · © 2019 The Author(s)

Also available as PDF (figures and tables appear in the PDF).

Keywords: Lymph nodes tuberculosis; Undifferentiated nasopharyngeal carcinoma (UCNT); Lymph nodes metastasis

Discussion

of the nasopharynx filling the Rosen Muller fossa and necrot-

ic adenomegalies of all the cervical and retropharyngeal chains. Chronic cervical adenopathies are a common reason for ears, nose,

Anatomopathological study of the biopsy curettage of the cavum and throat (ENT) consultation. The etiology may be infectious, in-

confirmed the diagnosis of the undifferentiated nasopharyngeal cluding tuberculosis, or malignant (hemopathy, metastasis of solid

carcinoma (UCNT) of nasopharynx.

cancer). The diagnostic approach depends on clinical and epidemi-

ological context.

No other location of tuberculosis was found and UCNT

was classified T2N2M0 stage.

Tunisia remains, like the third world countries, endem-

ic of tuberculosis, especially in its cervical lymph node location

Treatment was provided in collaboration with infectious which represents the most frequent localization of extra-pulmo-

disease specialists and oncologists. The patient received combined nary tuberculosis. On the other hand, we are also a country of

TB treatment with a standard protocol for a total of nine months intermediate endemicity for the UCNT of the nasopharynx which

(two months of isoniazid (H), rifampicin (R), pyrazinamide (Z) is frequently revealed by the presence of cervical adenopathies.

and ethambutol (E) (HRZE) quadritherapy and seven months of

heartbeats (HR) bitherapy). The anti-cancer protocol was started However, the association of tuberculosis and cancer has

fifteen days after the initiation of antituberculous treatment with been described by several authors,5 who suggest that the simulta-

neo-adjuvant chemotherapy, followed by concomitant chemoradineous or secondary existence of both disorders in the same patient

otherapy.

is favored by a state of chronic immunosuppression. However, the

presence in the same adenopathy of a tuberculosis infection and a

After a follow-up of 18-months, the clinical and radioneoplasia is rare, commonly described in patients with breast can-

5-7 logical examination (cervical ultrasound and facial magnetic rescer or lung cancer or lymphoma5-7 than in patients with a squa-

2,3,8 onance imaging (MRI)) do not find any tumour or tuberculosis mous cell carcinoma of the head and neck. To our knowledge,

recurrence.

the case that we report, of coexistence of cervical tubercular lym-

phadenitis and cervical metastatic lymph nodes of undifferentiated

cavum cancer, is the second case described in the literature.4

Physiopathologically, the Mycobacterium Tuberculosis can es-

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