Pancreatic and peripancreatic tuberculosis presenting as hypoechoic mass and malignancy diagnosed by ultrasound-guided fine-needle aspiration cytology

Abstract

Background:Pancreatic and peripancreatic tuberculosis is an extremely uncommon disease, presenting as hypoechoic mass on ultrasonography and imaging mimicking malignancy. Consequently, it represents a diagnostic challenge.Aims:To study 14 unusual cases of pancreatic and peripancreatic tuberculosis undergoing ultrasound-/endoscopic-guided fine-needle aspiration cytology (FNAC) in the 5-year period from 2006 to 2010.Materials and Methods:Endoscopic-guided FNAC was done in two cases, while ultrasound-guided FNAC was performed in 12 cases using 22-G needles via a percutaneous transabdominal approach. The aspirated material was quickly smeared onto glass slides, air dried, and wet fixed in 95% ethyl alcohol for subsequent Papanicolaou staining.Results:All pancreatic and peripancreatic tuberculosis cases showed solid-cystic pancreatic mass. Smears showed epithelioid cell granulomas, multinucleated giant cells, mixed inflammatory cells and histiocytes against a necrotic background. The common anatomic locations were the head, peripancreatic, tail and body of the pancreas.Conclusions:Ultrasound-/endoscopic-guided FNAC is a safe, reliable and cost-effective method for preoperative diagnosis of pancreatic and peripancreatic tuberculosis. Clinical symptoms and accurate diagnostic approach by ultrasound-/endoscopic-guided FNAC of pancreatic and peripancreatic tuberculosis is needed to avoid performing redundant laparotomy. Despite its rarity, pancreatic and peripancreatic tuberculosis should be considered for differential diagnosis of pancreatic and peripancreatic cystic mass in endemic developing countries.

Pancreatic tuberculosis

“…4,6,8,18,21,23,25,26 The clinical symptomatology can be diverse and include abdominal pain, loss of appetite and weight, and jaundice which may be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. 4,[7][8][9][18][19][20][21][22][23][24][25]27 The number of patients presenting with abdominal pain varies from 28.6 to 100% in various series. 4,[7][8][9][18][19][20][21][22][23][24] No specific pain characteristic has been reported in patients with pancreatic tuberculosis, and the published reports describe the pain variably as abdominal pain and/or discomfort.…”

“…Most reports of pancreatic tuberculosis indicate a preponderance of males in the reported cases except for two reports from China and South Korea. 4,[6][7][8][9][18][19][20][21][22][23][24][25][26] The mean age (or median) in various published series varied from 36 to 56 years suggesting that most patients are affected in the fourth to fifth decade of life. 4,6,8,18,21,23,25,26 The clinical symptomatology can be diverse and include abdominal pain, loss of appetite and weight, and jaundice which may be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy.…”

“…4,[6][7][8][9][18][19][20][21][22][23][24][25][26] The mean age (or median) in various published series varied from 36 to 56 years suggesting that most patients are affected in the fourth to fifth decade of life. 4,6,8,18,21,23,25,26 The clinical symptomatology can be diverse and include abdominal pain, loss of appetite and weight, and jaundice which may be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. 4,[7][8][9][18][19][20][21][22][23][24][25]27 The number of patients presenting with abdominal pain varies from 28.6 to 100% in various series.…”

“…4,[7][8][9][18][19][20][21][22][23][24][25]27 The number of patients presenting with abdominal pain varies from 28.6 to 100% in various series. 4,[7][8][9][18][19][20][21][22][23][24] No specific pain characteristic has been reported in patients with pancreatic tuberculosis, and the published reports describe the pain variably as abdominal pain and/or discomfort. Fever has been reported in all cases in some series and has not been reported as a symptom in other series.…”

“…In recent times there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. [1][2][3][4][5][6][7][8] This is possibly because of availability of better imaging modalities as well as the ability to obtain specimens from the pancreas. This review will focus on the available literature regarding the clinical features, diagnosis, evaluation, and treatment of pancreatic tuberculosis.…”