Isolated pancreatic tuberculosis mimicking pancreatic cancer in an immunocompetent host: An elusive diagnosis

Abstract

Isolated pancreatic tuberculosis is a very rare condition, even in areas of the world where the disease is highly prevalent. We report the case of isolated pancreatic tuberculosis in 54-year-old immunocompetent women, presenting as a solid mass of the pancreatic head with multiple lymphadenopathy mimicking a pancreatic carcinoma. The diagnosis was made with endoscopic ultra sound with fine needle aspiration and the treatment with anti-tuberculosis agents allowed the disappearance of the pancreatic mass and the regional lymphadenopathy. This case emphasizes the diagnostic challenge of this disease based on imaging findings because of a wide range of anomalies as carcinoma like masses, cystic lesions, or abscesses, which makes the Endoscopic ultrasound with fine needle aspiration the diagnostic modality of choice for pancreatic tuberculosis providing tissue samples for staining, cytology, culture, and polymerase chain reaction assay. Through this case we show that it is imperative to suspect pancreatic tuberculosis, as an appropriate treatment with antituberculosis drugs allows full recovery and avoids unnecessary surgery.

Pancreatic Tuberculosis—A Condition That Mimics Pancreatic Cancer

“…The imaging methods that can be used to diagnose pancreatic tuberculosis are abdominal ultrasonography, CT, MRI, endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS) [6]. The radiological changes can be classified into three categories: mass-forming, nodular form, or diffuse form [34]. In most cases, imaging in pancreatic tuberculosis reveals the presence of a pancreatic mass (79.5%) located most frequently in the pancreatic head (59%) [6].…”

Pancreatic Mass: Include Tuberculosis in the Differential Diagnosis

“…Since pancreatic neoplasms have analogous presentations, the ambiguity often leads to unwarranted surgical resection of the pancreatic mass. Endoscopic ultrasoundguided fine-needle aspiration (EUS-FNA) is the diagnostic modality of choice for pancreatic TB [5]. It is less invasive, carries lower risks when compared to laparotomy, and can provide a conclusive diagnosis by providing samples for HPE.…”