Mycobacterial spindle cell pseudotumour: epidemiology and clinical outcomes

J Clin Pathol. 2018 Jul;71(7):626-630. doi: 10.1136/jclinpath-2017-204777. Epub 2018 Jan 24.

Abstract

Introduction: Mycobacterial spindle cell pseudotumour (MSP) is a rare disease characterised by tumour-like local proliferation of spindle-shaped histiocytes containing acid-fast positive mycobacteria. The aim of this literature review is to describe the clinical parameters and treatment outcomes of patients with MSP.

Methods: A literature search was conducted using the search terms related to mycobacteria and spindle cell tumours. A previously unreported stem cell transplant recipient from our institution diagnosed with MSP was also included. Demographics, comorbidities, site of infection, treatment and clinical outcomes were analysed.

Results: Fifty-one patients were analysed. Twenty-six (51%) had HIV infection. Mycobacterium avium complex was the most frequent organism isolated in 24 (47.1%) followed by Mycobacterium tuberculosis complex in eight (16%) cases. Lymph nodes were the most common site of infection (45.1%). Twenty (39.2%) patients received antimycobacterial agents, 12 (23.5%) underwent surgical resection and six (11.8%) received antimycobacterial agents plus surgery. Treatment was successful in 24 (47.1%) patients and failed in 15 (29.4%); 13 of these 15 patients died. Antimycobacterial therapy was significantly associated with successful outcome compared with surgical resection or no treatment (P<0.001).

Conclusion: MSP is a rare condition associated primarily with immunodeficiencies. Antimycobacterial therapy is significantly associated with successful outcome.

Keywords: immunocomprised host; immunodeficiency; infections; mycobacteria.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antitubercular Agents / therapeutic use
  • Biopsy
  • Child
  • Child, Preschool
  • Female
  • Granuloma, Plasma Cell / diagnosis
  • Granuloma, Plasma Cell / epidemiology*
  • Granuloma, Plasma Cell / microbiology
  • Granuloma, Plasma Cell / therapy
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Mycobacterium Infections, Nontuberculous / diagnosis
  • Mycobacterium Infections, Nontuberculous / epidemiology*
  • Mycobacterium Infections, Nontuberculous / microbiology
  • Mycobacterium Infections, Nontuberculous / therapy
  • Mycobacterium avium Complex / drug effects
  • Mycobacterium avium Complex / isolation & purification*
  • Mycobacterium tuberculosis / drug effects
  • Mycobacterium tuberculosis / isolation & purification*
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Tuberculosis / diagnosis
  • Tuberculosis / epidemiology*
  • Tuberculosis / microbiology
  • Tuberculosis / therapy
  • Young Adult

Substances

  • Antitubercular Agents