[A case of pulmonary tuberculosis associated with triple cancer]

A 76-year-old man came to our hospital complaining of bloody sputum and anterior chest pain. He had undergone operations for rectal cancer six years previously and for gastric cancer nine months previously. His chest X-ray film showed a mass shadow in the left lower field and a small nodular shadow in the right middle field. After treatment with antibiotics and antituberculosis drugs, symptoms and laboratory findings improved and left mass shadow on the chest X-ray film began to resolve. Adenocarcinoma of the lung was diagnosed after a transbronchial lung biopsy from the right S3a. An operation was scheduled for two months later, but a new mass shadow appeared in the right lower field. Right upper lobectomy with mediastinal lymph node dissection and partial resection of the right S9 was done. The surgical specimens revealed well-differentiated adenocarcinoma from the right S3a and tuberculosis from the right S1, S2, and S9. A recent increase in multiple cancers has been noticeable, but cases of triple cancer concurrent with tuberculosis are rare. When chest-radiographic abnormalities unrelated to the original tumor occur in lung cancer patients, a second primary cancer should be considered. It is also important to determine if they are caused by intra-lung metastases or by some other condition, such as exacerbation of pulmonary tuberculosis.