Pancreatic Tuberculosis: Still a Histopathological Diagnosis

Abstract

Background: Pancreatic tuberculosis is usually unsuspected as it can present in various forms. Though an uncommon disease, once diagnosed it is potentially curable. Patients and Methods: Retrospective review of the records of 9 patients with histologically proven tuberculosis of the pancreas. Results: In none of the 9 patients was a preoperative diagnosis of tuberculosis possible. The diagnoses considered included: pancreatic cancer (n = 5); acute pseudocyst (n = 1); pancreatic abscess (n = 1); chronic pancreatitis with pancreatic head mass (n = 1), and carcinoma of the colon causing massive lower gastrointestinal bleeding (n = 1). All the patients underwent surgery. The diagnosis of tuberculosis was confirmed by histopathological examination of biopsy specimens obtained at the time of laparotomy. One patient died, the remaining patients received antitubercular therapy and are doing well at a median follow-up period of 26 months. Conclusion: In view of the nonspecific and variable clinical presentation and atypical radiological signs, a clinical diagnosis of pancreatic tuberculosis is usually not possible. Therefore there should be a high index of suspicion for this disease in young patients residing in endemic areas. Our experience highlights the importance of performing biopsy in apparently inoperable pancreatic mass lesions.

Pancreatic Tuberculosis

“…FNAC is the [54] 2002 Negative Kumar et al [8] 2003 Positive Veerabadran et al [32] 2007 Negative Mangla et al [55] 2 0 1 3 _ Meesiri et al [12] 2014 Positive Fig. 1 CECT showing pancreatic mass in head with hypodense collection easiest and non-invasive method of diagnosing pancreatic tuberculosis.…”

Pancreatic tuberculosis

“…This diagnosis was incidentally made during histopathological evaluation of the surgical specimen in patients undergoing pancreatic resection for a presumed pancreatic malignancy. [9][10][11] Not only does pancreatic tuberculosis mimic pancreatic cancer, it also causes diagnostic confusion with other pancreatic disorders like pancreatic cystic neoplasms, chronic pancreatitis, and autoimmune pancreatitis. 7,[12][13][14][15][16][17] Because the disease is uncommon even in the regions endemic for tuberculosis, the diagnosis is often missed or delayed in most cases.…”

“…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.…”

“…4,6,8,18,21,23,25,26 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.…”

“…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.…”