Localization of bronchogenic carcinoma in tuberculous lobes

The pronounced predilection of bronchogenic carcinoma for tuberculous lobes of the lungs is not generally recognized. In this plus 11 other series of patients with coexisting disease, an average of 52% had the neoplasm in a tuberculous lobe. In the present study, tuberculosis was confined to one or two lobes in 24 of 27 patients (89%) with coexisting disease; 21 (88%) of these patients had the neoplasm in a tuberculous lobe. Diagnosis required an average of 1.8 months (one week to 18 months). A low index of suspicion can delay diagnosis of the carcinoma until hilar enlargement, tumor, or metastasis is apparent radiologically, By then, often the tumor has become inoperable. Our data suggest that carcinoma should be suspected in a tuberculous man of cancer age who smokes and who has a lesion which is enlarging, is in an unusual location, or is drug resistant. Cytologic study of sputum, bronchoscopy, and early thoractomy are advocated.