Imagination beyond imaging – when tuberculosis mimics endometrial cancer spread: a case report

ABSTRACT

Background. In Europe, endometrial cancer ranks fourth among female neoplasms. Tuberculosis is one of the most common diseases affecting health globally. Moreover, tuberculosis is notorious for its ability to mimic other conditions, including cancer, especially when imaging results are misleading.
Case presentation. The present case involves a 72-year-old patient who presented to the gynecological outpatient clinic with complaints of abnormal uterine bleeding. A diagnostic hysteroscopy led to the diagnosis of endometrial endometroid adenocarcinoma, moderately differentiated. Pre-operative staging using PET/TC scan revealed abnormal tracer accumulation in the lymph nodes along the right common iliac vessels, raising suspicion for metastasis. Based on this information, the patient was considered as an intermediate/high risk candidate for minimally invasive surgery, and underwent a total laparoscopic hysterectomy, together with bilateral salpingo-oophorectomy and bulky lymphadenectomy.
Final histopathology revealed endometrioid adenocarcinoma of the uterine body, moderately differentiated (G2), hypermutated subtype, infiltrating beyond the internal half of the myometrium. Surprisingly, Mycobacterium tuberculosis complex was found in the lymph nodes. This finding completely changed the patient’s follow-up and prognosis leading to brachytherapy and anti-tuberculosis 4-drug therapy.
Conclusions. The concurrency of endometrial carcinoma and tuberculosis (TB) is extremely rare, with only 9 cases reported in the living literature. However, clinicians must consider the possibility of their coexistence, especially in regions where tuberculosis is endemic and in the context of endometrial malignancy with abdominopelvic lymphadenopathy.
Close collaboration among multidisciplinary teams is essential to achieve optimal outcomes in such challenging and rare cases.