title: Significance of coexistent granulomatous inflammation and lung cancer.
abstract: OBJECTIVE
  Coexistence of lung cancer and granulomatous inflammation in the same patient confuses clinicians. We aimed to document the prevalence, clinicopathological features, treatment outcomes and prognosis in patients with coexisting granulomatous inflammation undergoing curative lung resection for lung cancer, in a tuberculosis (TB)-endemic country.
  
  
  METHODS
  An observational cohort study of patients with lung cancer undergoing curative resection between 2012 and 2015 in a tertiary centre in Singapore.
  
  
  RESULTS
  One hundred and twenty-seven patients underwent lung resection for cancer, out of which 19 (14.9%) had coexistent granulomatous inflammation in the resected specimen. Median age was 68 years and 58.2% were males. Overall median (range) survival was 451 (22-2452) days. Eighteen (14%) patients died at median duration of 271 days after surgery. The postsurgery median survival for those alive was 494 (29-2452) days in the whole group. Subgroup analysis did not reveal any differences in age, gender, location of cancer, radiological features, type of cancer, chemotherapy, history of TB or survival in patients with or without coexistent granulomatous inflammation.
  
  
  CONCLUSIONS
  Incidental detection of granulomatous inflammation in patients undergoing lung resection for cancer, even in a TB-endemic country, may not require any intervention. Such findings may be due to either mycobacterial infection in the past or 'sarcoid reaction' to cancer. Although all patients should have their resected specimen sent for acid-fast bacilli culture and followed up until the culture results are reported, the initiation of the management of such patients as per existing lung cancer management guidelines does not affect their outcome adversely.
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Rucha S
authors.initials: RS
authors.lastname: Dagaonkar
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Caroline V
authors.initials: CV
authors.lastname: Choong
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Atasha Binti
authors.initials: AB
authors.lastname: Asmat
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Dokeu Basheer A
authors.initials: DB
authors.lastname: Ahmed
authors.affiliation: Johns Hopkins Singapore, Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Akhil
authors.initials: A
authors.lastname: Chopra
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Albert Y H
authors.initials: AY
authors.lastname: Lim
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Dessmon Y H
authors.initials: DY
authors.lastname: Tai
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Ai Ching
authors.initials: AC
authors.lastname: Kor
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Soon Keng
authors.initials: SK
authors.lastname: Goh
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: John
authors.initials: J
authors.lastname: Abisheganaden
authors.affiliation: Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: Akash
authors.initials: A
authors.lastname: Verma
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D015769:Granuloma, Respiratory Tract / Q000150:complications* / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000150:complications / Q000473:pathology; D008175:Lung Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged
keywords: GRANULOMA; LUNG CANCER; SURGERY; TUBERCULOSIS