Pancreatic tuberculosis

Abstract

Pancreatic tuberculosis is very rare, but recently, there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. It closely mimics pancreatic cancer, and before the advent of better imaging modalities it was often detected as a histological surprise in patients resected for a presumed pancreatic malignancy. The usual presentation involves abdominal pain, loss of appetite and weight, jaundice which can be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. Computed tomography (CT) of the abdomen is an important tool for evaluation of patients with pancreatic tuberculosis. This CT imaging yields valuable information about the size and nature of tubercular lesions along with the presence of ascites and lymphadenopathy. However, there are no distinctive features on CT that distinguish it from pancreatic carcinoma. Endoscopic ultrasound provides high resolution images of the pancreatic lesions as well as an opportunity to sample these lesions for cytological confirmation. The presence of granulomas is the most common finding on histological/cytological examination with the presence of acid fast bacilli being observed only in minority of patients. As there are no randomized or comparative studies on treatment of pancreatic tuberculosis it is usually treated like other forms of tuberculosis. Excellent cure rates are reported with standard anti tubercular therapy given for 6-12 months.

Common and uncommon imaging features of abdominal tuberculosis

“…Pancreatic TB most commonly presents as a solitary lesion with multiple cystic components. It is typically located in the pancreatic head; peripancreatic lymphadenopathy can be found along with additional features of other abdominal organ involvement (Fig. ).…”

Pancreatic Mass: Remember Tuberculosis—A Rare Cause of Pancreatic Mass

“…The approach to the case of pancreatic mass with suspicion of tuberculosis has been described by Sharma et al, 12 according to which if tumor mass seems unresectable, then USG/CT-guided FNAC should be done. Whereas if it is resectable, then EUS-guided FNAC should be taken for confirmation before going for any definitive procedure.…”

Calcified peripancreatic lymph nodes in pancreatic and hepatic tuberculosis mimicking pancreatic malignancy

“…Mycobacterium tuberculosis, still a serious menace to human health, can infect almost any organ in the human body. [ 1 , 2 ] Nevertheless, hepatic involvement is rare and pancreatic involvement is extremely rare. [ 2 – 4 ] Majority of cases of pancreatic tuberculosis occur as a part of disseminated tuberculosis, particularly in those with immunodeficiency.…”

“…[ 1 , 2 ] Nevertheless, hepatic involvement is rare and pancreatic involvement is extremely rare. [ 2 – 4 ] Majority of cases of pancreatic tuberculosis occur as a part of disseminated tuberculosis, particularly in those with immunodeficiency. [ 4 , 5 ] The diagnosis of pancreatic tuberculosis can easily be missed or significantly delayed because of its rarity and lack of specificity.…”

“…[ 4 , 5 ] The diagnosis of pancreatic tuberculosis can easily be missed or significantly delayed because of its rarity and lack of specificity. [ 2 , 3 , 6 , 7 ] Two articles reported the isolated tuberculosis lesion at liver or around the head of pancreas involved both liver and pancreas. [ 8 , 9 ] One article reported pancreatic and hepatic tuberculosis without involvement of other organs in an infant.…”