A 68-year-old female patient complaining of vaginal itching and pain presented a vulvar mass, vaginal invasion at gynecological examination on December 2011. She denied tobacco smoking. Tumoral biopsy diagnosed vulvar squamous cell carcinoma. Staging exams included pelvic MRI, abdominal and thoracic computed tomography (CT), the later revealing two spiculated irregular lung nodules (Figure 1), establishing the diagnosis of a T3 N0 M1 (lung), stage IV vulvar carcinoma. As the patient did not present the typical and expected pelvic and/or inguinal lymph node involvement, we decided to biopsy the lung nodules, to confirm the diagnosis of metastasis.
Thus, two nodules were biopsied, revealing the presence of chronic inflammatory reaction with granulomas (Figure 2A) and the Ziehl-Neelsen staining was positive for mycobacteria, consistent with the diagnosis of pulmonary tuberculosis (Figure 2B). No evidence of neoplasia was found in the biopsied specimen.
After the diagnosis of pulmonary tuberculous nodules, the patient was referred to gynecological surgery, with curative intention, as a T3 N0 M0 vulvar cancer, and started the antituberculous standard treatment.