INTRODUCTION

Lung Adenocarcinoma with positive Rapid Molecular Screening from BAL is a rare cases. As we
know Lung Adenocarcinoma can be risk factor of Pulmonary Tuberculosis after treatment. In
this case the patient positive acid fast bacilli from Bronchoalveolar Lavage after Bronchoscopic
procedures.

Fig 1 Chest X-Ray Fig 2 CT Scan Thorax June 22, 2019

July 10, 2019
Before taken Showed a pulmonary mass of the right lung and
tuberculosis a multiple metastasis lymph node at mediastinum
drugs and
chemotheraphy

CASE

78-year-old male with chest pain for 3 months VAS 5-6 additional symptoms of shortness of
breath 6 months and cough. Patient had been experiencing loss of weight about 2 kilograms in
1 month. History of wheeze for 6 months. History of smoking for 30 years with BI: severe.
History of Diabetes was found. The chest x-ray showed a homogenous consolidation with
infiltration at the right lung. CT Scan Thorax showed a pulmonary mass of the right lung and
multiple metastasis lymph node at mediastinum, and the bronchoscopic showed features of
stenosis infiltration in trunkus intermedius.The hispathology from bronchial biopsy is
Adenocarcinoma.

Fig 3. The Bronchoscopic showed features of stenosis infiltration and nodule in trunkus
intermedius, the forceps biopsy has been done
 Fig. 4 Fig. 5 Fig.6
Biopsy tissue preparations EGFR mutation status : No Rapid molecular
in the form of fragments Mutation Detected screening of
with oval rounded cell pulmonary
nucleus, enlarged, rough tuberculosis from
chromatin, protruding bronchoalveolar
nucleoli, eosinophilic lavage was positive
cytoplasm.

DISCUSSION
As TB became less common and its manifestations more nonspecific flexible fiberoptic
bronchoscopy has been reported more frequently for diagnosingTB. This is especially true in
pulmonary TB, where sputum often is negative. The overall yield of bronchoscopy for
diagnosing TB has been greater than 90 percent when cultures were included in the analysis. In
addition patients who were sputum smear-negative for TB still had a greater than 90 percent
yield for M tuberculosis. Smoking and air pollutions are the two major risk factors causing airway
diseases by repeatedly irritating respiratory epithelium, resulting in a chronic inflammatory
condition. COPD is a known risk for lung cancer. Lung infections, including tuberculosis, have
been implicated as potentially contributing to the etiology of lung cancer. Tuberculosis may
increase the risk of lung cancer through substantial and prolonged pulmonary inflammation,
leading to host tissue damage, fibrosis, scar formation, and genetic alterations.
\
Fig 7. Chest X-Ray July 26, 2019
After 1 month chemotheraphy and tuberculosis drugs
Conclusion
CONCLUSION
CONCLUSION
Lung adenocarcinoma with pulmonary tuberculosis with chronic obstructive pulmonary disease
and with type 2 diabetes was a rare cases. The bronchoalveolar lavage was positive from Rapid
Molecular Screening after bronchoscopic procedures.The patient has been given
chemotheraphy for 1 cycle with Karboplatin + Venoralbine and 1 month Tuberculosis drugs. The
Chest X-Ray showed improvement.

REFERENCE

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Tuberculosis and Rifampicin Resistance, September 9, 2010

2. Meredith S. Shiels, Demetrius Albanes, Jarmo Virtamo and Eric A. Engels, Increased Risk
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Prevention Study, Published April 2011.

3. Robert P.Baughman,M.D.,F.C.C.P.; Michael N. Dohn, M.D. et all, Bronchoscopy with

Bronchoalveolar Lavage in Tuberculosis and Fungal Infections Chest Volume 99, Issue 1,
January 1991, Pages 92-97.

4. Yang-Hao Yu, MD,* Chien-Chang Liao, PhD, et all, Increased Lung Cancer Risk among
Patients with Pulmonary Tuberculosis A Population Cohort Study, Journal of Thoracic
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