J Korean Surg Soc.  2002 Nov;63(5):432-436.

Concomitant Gastric and Hepatic Tuberculosis Misconceived as a Malignant Gastrointestinal Stromal Tumor with Hepatic Metastasis

• Kim SJ
• Kim W

Abstract

Diagnosis of gastric and/or hepatic tuberculosis is often delayed or missed because of its non-specific symptomatology and rare occurrence. We present here a rare case of concomitant gastric and hepatic tuberculosis which was preoperatively mistaken for a malignant gastrointestinal stromal tumor (GIST) with hepatic metastasis in a 49- year-old male. The patient, with no past history of pulmonary tuberculosis, was admitted with indigestion and epigastric discomfort for 2 weeks. There were no abnormal findings on physical examination and chest radiology. Gastrofiberscopic examination revealed a large, submucosal tumor with central ulceration on the middle third of the stomach and biopsy targeted on the ulceration site showed only chronic inflammation. Abdominal CT showed an exophytic, ovoid gastric mass having calcified components on the side of lesser curvature with huge, inhomogenous hepatic masses in the left lobe, requiring differentiation from possible hematogenous metastasis of gastric lesion, most likely malignant GIST. The patient underwent distal gastrectomy and left lobectomy of the liver. The case was confirmed pathologically as tuberculosis showing confluent epithelioid cell granulomas and multinucleated giant cells with caseous necrosis.

Keyword

Tuberculosis; Stomach; Liver

MeSH Terms

Biopsy
Diagnosis
Dyspepsia
Epithelioid Cells
Gastrectomy
Gastrointestinal Stromal Tumors*
Giant Cells
Granuloma
Humans
Inflammation
Liver
Male
Necrosis
Neoplasm Metastasis*
Physical Examination
Stomach
Thorax
Tomography, X-Ray Computed
Tuberculosis
Tuberculosis, Hepatic*
Tuberculosis, Pulmonary
Ulcer