Tuberculosis diagnosed after major hepatectomy for suspected malignancy

A patient with a history of surgery and adjuvant chemotherapy 2 1/2 years previously for Dukes C colonic adenocarcinoma was diagnosed with a focal liver lesion on follow-up examinations. Ultrasound and computed tomography scan revealed a 3.8 cm soft tissue mass. Positron emission tomography scan showed intense uptake, corroborating the diagnosis of a colonic liver metastasis. Major hepatectomy was performed but pathology revealed that the lesion was in fact a benign tuberculosis pseudo-tumour. In developed countries liver tuberculosis remains extremely rare, particularly the macronodular form. The diagnosis is often made only after hepatectomy for suspected malignancy. The increasing use of potent anticancer chemotherapy may favour the reactivation of quiescent tuberculosis, posing a difficult differential diagnosis with liver metastases.