Malignant bronchial ulcer with coexistent pulmonary tuberculosis

Area of Science:

• Pulmonology
• Oncology
• Pathology

Background:

• Bronchial ulcers are uncommon findings during bronchoscopy.
• Deep necrotic bronchial ulcers are exceptionally rare in clinical settings.
• Historically, endobronchial tuberculosis was a frequent cause of bronchial ulceration.

Observation:

• A 70-year-old male, a chronic smoker, presented with dyspnea, cough, weight loss, and appetite loss.
• Bronchoscopy revealed a large, necrotic, friable bronchial ulcer with dense anthracotic pigmentation.
• Endobronchial biopsy indicated poorly differentiated bronchogenic carcinoma; TBNA showed caseous necrosis.

Findings:

• The patient was diagnosed with poorly differentiated bronchogenic carcinoma, pulmonary tuberculosis, and chronic obstructive pulmonary disease (COPD).
• This represents the first reported case of a malignant bronchial ulcer presenting as a deep necrotic lesion.

Implications:

• Highlights the importance of considering malignancy in patients with deep necrotic bronchial ulcers, even with concurrent infections.
• Emphasizes the need for thorough diagnostic workup, including biopsies and mediastinal node evaluation.
• Suggests a multimodal treatment approach involving chemotherapy, anti-tuberculosis therapy, and COPD management.