title: Gallbladder cancer management impacted by coexistent tuberculosis.
abstract: BACKGROUND
  In endemic areas, gallbladder cancer (GBC) and tuberculosis may coexist. This study aimed to ascertain the impact of coexistent tuberculosis on the management of patients with GBC.
  
  
  METHODS
  Data of patients with proven GBC with coexistent tuberculosis managed at our centre between January 2003 and December 2007 were analysed from a prospective gallbladder cancer database to highlight the management issues and ascertain the impact that coexistent tuberculosis had on the outcome in these patients.
  
  
  RESULTS
  Of the 340 patients of GBC evaluated at our centre, 7 patients had concomitant tuberculosis and constituted the study group. All the patients were women (mean age 56.3 years). The commonest presenting symptoms were abdominal pain, decreased appetite and significant weight loss. Two patients were found to have tuberculosis on preoperative evaluation on a fine-needle aspiration cytology from the left supraclavicular lymph nodes; 3 patients were detected intraoperatively (1 had peritoneal tuberculosis on staging laparoscopy and 2 had tubercular lymphadenitis on interaortocaval lymph node sampling) and 2 were detected postoperatively with histopathological examination showing GBC with tubercular lymphadenitis of the hepatoduodenal lymph nodes. Six of these 7 patients underwent surgery with curative intent and 1 underwent a surgical bypass.
  
  
  CONCLUSIONS
  Five of the 7 patients of GBC with coexistent tuberculosis could have been denied the chance of curative surgery had a preoperative/intraoperative biopsy confirmation not been done. Thus, histopathological confirmation is mandatory before labelling a cancer as metastatic and denying the patient a chance for cure.
authors.affiliation: Department of GI Surgery GB Pant Hospital & MAM College, Delhi University, New Delhi, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Javed
authors.affiliation: Department of GI Surgery GB Pant Hospital & MAM College, Delhi University, New Delhi, India.
authors.forename: Asit
authors.initials: A
authors.lastname: Arora
authors.affiliation: Department of GI Surgery GB Pant Hospital & MAM College, Delhi University, New Delhi, India.
authors.forename: Raja
authors.initials: R
authors.lastname: Kalayarasan
authors.affiliation: Department of GI Surgery GB Pant Hospital & MAM College, Delhi University, New Delhi, India.
authors.forename: Puja
authors.initials: P
authors.lastname: Sakhuja
authors.affiliation: Department of GI Surgery GB Pant Hospital & MAM College, Delhi University, New Delhi, India.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000556:secondary / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D014397:Tuberculosis, Pulmonary / Q000150:complications*