Lymph nodeenlargement in cancer patients often directs to a metastatic disease leading to unnecessary lymph node dissection. But in developing countries, where tb is very prevalent, any lymph node enlargement specially in immunocompromised patients should warrant us to investigate further before dissection and rule out tb in tb endemic countries. Tuberculous lymphadenopathy in cancer patients is increasing in number. Lymphadenopathy is the most common form of extrapulmonary lymphadenopathy and cervical lymph node enlargement if the most common site. there is limited literature on this aspect of inflammatory lymphadenopathy and radiologically enlarged lymph nodes in cancer patients. Here we present  a case of cervical lymphnode enlargement in patients of renal cell carcinoma .

Keywords: tuberculosis, renal cell carcinoma, extra pulmonary TB.

1. Lazarus AA, Thilagar B. Tuberculous lymphadenitis. Dis Mon 2007; 53:10-5.
2. Thompson MM, Underwood MJ, Sayers RD, Dookeran KA, Bell PRF. Peripheral tuberculous lymphadenopathy: a review of 67 cases. Br J Surg1992;79:763-4
3. Dandapat MC. Mishra BM, Dash SP, Kar PK. Peripheral lymph node tuberculosis: a review of 80 cases. Br J Surg1990;77:911-2.
4. Sharma SK, Mohan A. Extrapulmonary tuberculosis. Indian J Med Res 2004;120:316-53.
5. Sun M, Bianchi M, Hansen J, et al. Nodal involvement at nephrectomy is associated with worse survival: a stage-for-stage and grade-for- grade analysis. 1Int J Urol2013;20:372-80
6. Chandrasekaran S, King MR. Microenvironment of tumor-draining lymph nodes: opportunities for liposome-based targeted therapy. Int J Mol Sci 2014;15:20209-39.
7. Sharma B, Malhotra P, Bhardwaj M. Papillary renal cell carcinoma with tubercular paraaortic lymphadenopathy: a blessing in disguise. J Clin Diagn Res 2017;11:ED16-
8. Falagas ME, Kouranos VD, Athanassa Z, et al. Tuberculosis and malignancy. QJM 2010;103:461-87.
9. Godoy G, O’Malley RL, Taneja SS, Lymph node dissection during the surgical treatment of renal cancer in the modern era Int Braz J Urol2008 34:132-42
10. Ljungberg B, Words of wisdom. Re: Radical nephrectomy with and without lymph-node dissection: final results of european organization for research and treatment of cancer (EORTC) randomized phase 3 trial 30881 Eur Urol2009 55(6): 1486-87.  
11. Canfield SE, Kamat AM, Sánchez-Ortiz RF, Detry M, Swanson DA, Wood CG, Renal cell carcinoma with nodal metastases in the absence of distant metastatic disease (clinical stage TxN1-2M0): the impact of aggressive surgical resection on patient outcome J Urol2006 175(3 Pt 1):864-69
12. Handa U, Mundi I, Mohan SNodal tuberculosis revisited: a review. J Infect Dev Ctries 2012;6:612. doi:10.3855/jidc.2090http://www.ncbi.nlm.nih.gov/pubmed/22240421

Dr Hina Afreen

Senior Resident, Dept. of Pulmonary Medicine, Shadan Institute of Medical Sciences