A 32-year-old man presented with
asthenia,
weight loss,
cough, and
dysphagia following a recent stay in Morocco. Endoscopy showed a bulky mass of the epiglottis suspected of being a malignant
tumor. The patient underwent jointly an F-18 FDG PET/CT and a biopsy of the
tumor. Against all expectations, biopsy revealed granulomatous
inflammation with epitheloid giant cells and caeseating
necrosis. These findings associated with the presence of
acid-fast bacilli in the sputum smears were highly suggestive of
laryngeal tuberculosis, which was confirmed later after cultivation of mycobacteria. F-18 FDG PET showed diffuse pharyngolaryngeal and lung uptake with bilateral cervical and abdominal nodes, but also one thoracic vertebral uptake. Lung CT could have revealed carcinomatous dissemination, but cavitary lesions in some pulmonary segments were more evocative of
tuberculosis. Moreover, cerebral MRI showed brain
tuberculomas not visualized on F-18 FDG PET/CT. The patient was treated with a 5-antituberculosis
drug regimen, which improved clinical symptoms with epiglottis mass regression, and lung CT image reduction, clinching the systemic
tuberculosis diagnosis. A control F-18 FDG PET/CT performed 5 months later showed disappearance of the pharyngolaryngeal and node uptake, with an improvement of lung uptake without normalization, arguing for persistent disease. Unexpected pathologic findings may be present in more than 3% of
neck dissections. Although this is usually indolent, with the underlying SCC remaining the main prognostic determinate, it may significantly complicate postoperative management.