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LUNG CANCER IN COMBINATION WITH PULMONARY TUBERCULOSIS
FEATURES OF THE CLINICAL PICTURE AND MORPHOLOGY
Iskandarova Iroda Mashrabovna
Bukhara State Medical Institute, Bukhara, Uzbekistan
Abstract:
The combination of tuberculosis and lung cancer has long been considered a
controversial problem and is of interest to both clinicians and pathologists. The relationship
between the two diseases still remains unresolved and controversial. Some authors [1,3,4] believe
that pulmonary tuberculosis in most cases precedes cancer, being an important etiopathogenetic
moment in the development of bronchocarcinoma. Others are cautious about the role of
tuberculosis changes in cancer development, suggesting that tuberculosis and cancer develop
independently [5].
Keywords:
cancer, lung, morphology, tuberculosis.
Introduction
. The authors agree that tuberculosis and lung cancer coexist well. Attention is
drawn to the frequent development of cancer in the area of residual changes after tuberculosis.
With the increasing frequency of combination of cancer and tuberculosis of the lung, with the
improvement of diagnostic methods, more and more scientists suggest that post-tuberculosis
sclerotic changes create conditions for the development of lung cancer. In the literature, various
combinations of cancer and tuberculosis are cited, such as cancer in the rumen, cancer that
developed in the tuberculosis cavity, cancer around tuberculosis [1,2,7]. It should be noted that
difficulties often arise in the differential diagnosis of the two diseases. More than 22% of lung
cancer patients are mistakenly diagnosed with tuberculosis. True differential diagnostic
difficulties arise when the clinical picture is erased, there is no Mycobacterium tuberculosis in the
sputum, and an uncharacteristic X-ray picture [ 5,6,8]. Materials and methods: A combination of
cancer and various forms of tuberculosis was observed in 60 patients in the surgical department of
the Voronezh Regional Tuberculosis Dispensary from 2017 to September 2021. The control group
consisted of 50 patients who were diagnosed with only lung cancer in the period from 2017 to
September 2021. The main contingent of patients is men. The average age in the first group was
56 years, in the control group - 59 years. Cancer was verified morphologically in all patients.
When examining patients, the following diagnostic methods were used: X-ray, endoscopic
(fibrobronchos copy), cytological examination of sputum, the presence of Mycobacterium
tuberculosis in sputum was determined by the luminescent method and by seeding. Results and
discussion: The duration of tuberculosis disease before the diagnosis of lung cancer varied,
ranging from 1 to 15 years, with an average interval of 4 years. When analyzing the data obtained,
the combination of tuberculosis and S. A. Grigorenko's lung cancer was dominated by the
infiltrative form of tuberculosis - 31 patients (52%), and in 6 cases (10%) the cancer developed in
the same lobe of the lung. Focal tuberculosis was detected in 10 patients (17%), in 5 patients
(8%) in the same proportion, disseminated tuberculosis-in 3 (5%), fibrocavernous tuberculosis -
in 1 (2%), tuberculosis in 3 (5%) patients, primary tuberculosis complex in 1 patient. A
combination of active tuberculosis and lung cancer was found in 49 (81%) patients. In 11 (19%)
cases, lung cancer developed on the background of clinically cured pulmonary tuberculosis. The
number of patients observed in groups I A and I B of DU was equal: 19 patients ( 64%), 11
patients ( 18%) in group III of DU, 5 patients ( 8%) in group II of DU, and 6 patients (10%) in
group II of DU. Among 60 patients in group 1, squamous cell carcinoma prevailed in terms of
histological structure. It occurred in 27 patients (45%), it should be noted that in 19 (32%) patients
in combination with an infiltrative form of tuberculosis and in 8 (13%) cases with a focal form.
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Adenocarcinoma was detected in 14 (23%) cases, 8 of them (13%) in combination with
infiltrative tuberculosis, small cell cancer was detected in 5 (8%) patients, and one patient had
large cell cancer. Tumors were diagnosed in the right lung in 36 (60%) patients, and in the left
lung in 21 (35%). In 2 cases, metasynchrono cancer was detected, and one patient had lung
carcinomatous is without a primary focus. According to cancer stages, patients were ranked as
follows: the leading place was occupied by 26 (43%) patients with stage II, 16 (27%) patients
with stage III, 11(18%) patients with stage IV, and 7 (12%) patients with stage I. Here is our
observation. Patient M. born in 1953 was admitted to LHO 1 VOKPD on 2.11.1995. In 1994.
disseminated pulmonary tuberculosis with MBT (+) disintegration was detected, and after the
treatment, the resorption and compaction phase was achieved. Bacillus secretion stopped. X-ray
examination in 1995 revealed a rounded lump in the middle lobe of the right lung. I didn't file any
complaints when I received them. The department clarified the diagnosis-Peripheral cancer of the
middle lobe of the right lung of stage II T3T0M0. Disseminated pulmonary tuberculosis phase of
resorption and compaction of MBT ( -) I A gr. DU. During bronchoscopy: bronchi without
significant pathology. After preoperative preparation on 6.02.95, a resection of the middle lobe of
the right lung was performed. Histological diagnosis: low- grade adenocarcinoma. There are no
metastases to the l/nodes. After surgery, there was increased serous exudation into the right
pleural cavity. Wound healing by primary tension. At the control radiography , the right lung is
fully expanded, and the pneumatization is satisfactory. The dome of the diaphragm is deformed
by adhesions in the lower lobe of fibrosis bullae, and numerous small intense foci. On the left - no
special features. Received during hospitalization: tubazid-79.2, pyrazinomide-97.5, kanamycin-
59.0. At discharge, blood counts are within the normal range. In the group of patients with only a
diagnosis of lung cancer, 23 (46%) out of 50 patients had stage II of the disease, 20 (40%) had
stage III, I and IV had 2 (4%) patients each. The number of patients with squamous cell lung
cancer was 26 (52%), histologically confirmed adenocarcinoma was in 11 (22%) patients, small
cell cancer was detected in 3 (6%) patients, large cell cancer in 2 (4%), two patients were
diagnosed with lymphosarcoma and light cell cancer. Both in the first and control groups, there
were more patients with central lung cancer - 35 (58%) and 28 (56%), respectively. Peripheral
cancer was diagnosed in 22 (37%) cases in the first group and in 18 (36%) cases in the second
group. Radical surgical treatment for lung cancer in the first group of patients was possible in 26
patients, which was 43%, in the second group in 36 patients, which was 72%. In 25 patients with
a combination of cancer and tuberculosis of the lung, it was impossible to conduct surgical
treatment, due to severity of the condition and prevalence of the tumor process.
Conclusions
: 1.
The occurrence of lung cancer in the eponymous lobe affected by the tuberculosis process,
according to our material, was 18%. 2. The combination of lung cancer patients with infiltrative
tuberculosis prevails over the number of patients in combination with other forms of tuberculosis.
3. The number of patients with advanced-stage IV lung cancer was higher in the group of patients
in combination with tuberculosis. 4. Co-existing tuberculosis and lung cancer aggravates the
condition of patients and often does not allow them to conduct all the necessary studies and
perform routine surgical treatment.
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