Coexistent lung carcinoma and active pulmonary tuberculosis in the same lobe

We observed a rare case of lung carcinoma accompanied by active pulmonary tuberculosis in the same lobe. The chest x-ray of a 49-year-old man revealed an abnormal shadow in the right upper field and a giant bulla in the left upper field. Chest computed tomography (CT) revealed a nodule with consolidation, which was not continuous in the right S3. Bronchoscopically, epidermoid carcinoma existed in the proximal right upper bronchus. In the sputum specimens, the smear was negative, but the polymerase chain reaction of Mycobacterium tuberculosis and culture was positive. Anti-tuberculosis treatments were administered for approximately 4 weeks, but the chest x-ray remained unchanged. Right upper lobectomy with bronchoplasty (wedge resection of the right upper bronchus) was performed, and the anastomosis was covered with an intercostal muscle flap. Lymphadenectomy of the right hilum and mediastum was also performed. Microscopy revealed epidermoid carcinoma in the proximal tumor (pT3N0M0-stage IIB) and epithelioid granuloma with caseous necrosis, granulomatous pneumonia, exudative lesions, and fibrocaseous nodules in the distal lung. After surgery, anti-tuberculosis treatment was resumed.