Isolated hepatic tuberculosis masquerading as hepatic metast
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Oncologists have a natural tendency to suspect metastasis, in a patient with malignancy, who develops a visceral lesion. In a country like India, where tuberculosis is highly prevalent, it is imperative for doctors to exercise extreme caution, while evaluating an uncommon site of “visceral metastasis.” This article presents a unique instance where an isolated hepatic lesion in a boy with Ewing's sarcoma was highly suspicious of a metastatic lesion.

A 14-year-old boy presented with a history of pain and swelling in the right leg of 3 months duration. He was further evaluated with radiograph and magnetic resonance imaging, raising the suspicion of Ewing's sarcoma of right proximal fibula. The histopathological diagnosis of Ewing's sarcoma was confirmed with a core needle biopsy. Whole body positron emission tomography-computed tomography (PET-CT) evaluation, done as part of staging protocol, revealed a hepatic caudate lobe lesion of size 2.4 cm × 1.4 cm with maximum standardized uptake value (SUVmax) of 6.75 (SUVmax of primary 10.54) . This lesion although isolated was suspicious of hepatic metastasis. Multiple attempts by image-guided biopsy failed to demonstrate any evidence of malignancy. Hence, patient was given the “benefit of the doubt” and was labeled as nonmetastatic. He received 12 weeks of induction chemotherapy and subsequently underwent surgical excision of proximal fibula. Patient further received 26 weeks of adjuvant chemotherapy in accordance with the standard chemotherapy protocol of the institute for Ewing's sarcoma.