An unusual case of a pleural effusion with an abdominal mass.

A 38-year-old man presented to us with a left sided pleural effusion. Pleural fluid was aspirated and analysis revealed it to be an exudate with predominant lymphocytes and an elevated ADA level. He was discharged on antituberculous treatment. Patient returned with re-accumulation of pleural fluid. Computed tomography done in our institute picked up not only parenchymal disease in the lung which was not evident on chest radiographs but also picked up an abdominal mass in the left renal fossa. Pathological examination of excised mass revealed its tuberculous nature. The repeated recollection of pleural fluid was attributed to a "paradoxical response"; the patient was reassured and his anti-tuberculous treatment continued. Recognition of the fact that evidence of tuberculosis at distant sites may occasionally be needed to substantiate the diagnosis of tuberculous pleural effusion in a difficult and bacteriologically "negative" case prompted us to report this case.

Second primary lung cancer with tuberculosis.

We report a rare case of second primary lung cancer presenting metachronoulsy in a patient with laryngeal cancer. Though regional recurrence and second primary neoplasm of the upper aerodigestive tract are common following laryngeal cancers, second primary cancers of the lung are uncommon. Adding to the rarity of the case was the presence of concurrent active pulmonary tuberculosis with second primary neoplasm of the lung.

Pulmonary Tuberculosis with Pancoast Tumour.

A 56 year old man presenting with complaints of pain chest with radiation to the right arm and haemoptysis was found to have a right upper zone mass lesion with rib erosion on the X-ray chest, fine needle aspiration cytology of which revealed squamous cell carcinoma. Subsequently, sputum smear was found to be positive for acid fast bacilli by Ziehl Neelsen stain. Synchronous presence of Pancoast tumour of the lung with active pulmonary tuberculosis in the same lobe is a very rare association. To our knowledge, there has been no previous report of any similar case in literature.