Bone Tuberculosis Mimicking Bone Sarcoma: A Case Series and Literature Review

Abstract

Background: Pulmonary tuberculosis (TB) is routinely encountered in developing countries such as India. However, osteoarticular TB is rarely seen and frequently presents with an atypical clinical-radiological presentation that may mimic bone tumors. For such lesions involving the bones, we need to be more vigilant in both clinical and radiological terms. The aim of this study was to bridge the gap between diagnosis and management for achieving good outcomes. Methods: This retrospective study analyzed five cases referred to the orthopedic oncology unit with suspected bone sarcoma, based on clinical, radiological, and histopathological examinations (HPE). Results: A total of five cases (three male and two female patients) with the suspicion of bone sarcomas were included in this study. The mean age of the study group was 20.6 years. The mean values of blood parameters were as follows: hemoglobin (Hb) 9.88 g/dl, white blood cell (WBC) count 10820/μl, erythrocyte sedimentation rate (ESR) 85 mm/h, and C-reactive protein (CRP) 48.8 mg/l. Two patients (40%) had infections as one of the differential diagnoses. Radiological evaluation suggested infection in four of the five patients (80%). A biopsy was planned and sent for both HPE and culture. HPE was positive in all cases (100%), whereas culture was positive in 60% of cases. Conclusion: For all the aggressive bony lesions, a multidisciplinary team is of utmost importance for the diagnosis. The role of the oncopathologist is crucial in differentiating atypical presentations of osteoarticular TB from malignant bone tumors.