Malignant lymphoma mimics miliary tuberculosis by diffuse micronodular radiographic findings

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• A patient with a history of rectal cancer and suspected liver metastasis presented with diffuse lung shadows.
• Initial suspicion based on chest radiography was miliary tuberculosis.

Observation:

• Computed tomography revealed diffuse lung shadows appearing as miliary nodules bilaterally.
• Liver biopsy showed atypical lymphocyte infiltration, diagnosed as follicular lymphoma.
• Extensive bacteriologic tests for tuberculosis were negative.

Findings:

• Video-assisted thoracic surgery confirmed multiple small lymphocyte mass lesions in the lungs.
• The liver mass and lung lesions were determined to be tumor involvement by follicular lymphoma.
• Radiographic findings mimicked miliary tuberculosis, complicating the initial diagnosis.

Implications:

• This case underscores the importance of considering malignant lymphoma in the differential diagnosis of miliary lung opacities.
• It highlights the diagnostic challenges posed by rare presentations of follicular lymphoma.
• Emphasizes the need for comprehensive evaluation when initial findings are ambiguous.