CRA101 A TALE OF TWO PATHOLOGIES: TUBERCULOSIS AND SQUAMOUS CELL CARCINOMA COLLIDE

Afifah Kamarudin¹, Anez Aslan¹, Maisarah Rahman², Raymund Dass¹, Han Loong Tan¹

¹ Respiratory Unit, Department of Internal Medicine, Hospital Tuanku Ja’afar Seremban, Malaysia
² Otorhinolaryngology Department, Hospital Tuanku Ja’afar Seremban, Malaysia

Introduction
Tuberculosis (TB) and squamous cell carcinoma (SCC) are two distinct pathologies with markedly different etiologies, clinical courses, and management approaches. The coexistence of these conditions within the same anatomical region, particularly the nasopharynx or head and neck area, is rare and poses significant diagnostic and therapeutic challenges. This case highlights concurrent nasopharyngeal SCC and TB, underscoring the importance of histopathological vigilance in endemic areas.

Case Report
A 48 years old female with underlying pemphigus vulgaris presented with left submandibular swelling in September 2024. FNAC done shows metastatic squamous cell carcinoma. Further imaging of CT neck shows right cervical lymphadenopathy and left cervical lesion suggestive of enlarged necrotic lymph node; possible differentials of tuberculosis, metastasis or lymphoma. She underwent rigid scope which shows enlarged adenoid and biopsy taken came back positive for mycobacterium tuberculosis. Serum TB Quantiferon send was positive and she was started on anti TB treatment. She was managed with the otorhinolaryngology team for the metastatic squamous cell carcinoma and it was noted her left cervical lymph node reduced in size after initiation of anti TB medication.

Conclusion
Tuberculosis and squamous cell carcinoma may mimic each other clinically and radiologically. Overlapping symptoms such as cervical lymphadenopathy, nasal obstruction, and constitutional signs can obscure the presence of one condition when the other is already diagnosed. Biopsy is critical to distinguish between granulomatous inflammation or malignant cells and guide the treatment choice for the patient.