Tuberculosis of the Pancreas

Abstract

In a case report, the rate condition of tuberculosis of the pancreas is described. There are two conceivable ways in which the pancreas may become diseased: 1. toxic-allergic reaction of the pancreas in response to generalized tuberculosis (so-called concomitant pancreatis) 2. Invasion of the pancreas by tubercle bacteria disseminated via the blood, or through penetration of the organ by adjacent caseating abdominal lymph nodes. Histologically, epithelioid cells and Langhans' giant cells are only rarely found; caseation usually develops, with subsequent calcification, which can lead to stenosis of the pancreatic duct. In patients with generalized tuberculosis and abdominal complaints, the diagnosis is most reliably established on the basis of ERCP and CAT. In the presence of pain, resection of the affected portion of the pancreas may be considered as means of treatment.

Isolated Pancreatic Tuberculosis

“…[6,7] Contrastenhanced CT scans may demonstrate a focal hypodense mass, diffuse enlargement of the pancreas, but none of the signs are pathognomonic. Ring enhancement or low-density areas within enlarged lymph nodes should make one suspect tuberculous lymph nodes.…”

“…[1,[6][7][8][9][10] Once the diagnosis has been established, the majority of the patients with TB respond favourably to ATT. [6] Our patient did not have a personal or family history of TB and was immunocompetent, with no evidence of any other foci of TB.…”

Pancreatic Tuberculosis: Still a Histopathological Diagnosis

“…A history of tuberculosis is also reported in only a minority of patients [3]. Patients with pancreatic tuberculosis can present variably, in the form of locally advanced or metastatic pancreatic cancer [3, 16, 19], pancreatic abscess [17, 20], acute pancreatitis [21], chronic pancreatitis [18]or portal hypertension [22]. All these presentations were seen in our patients.…”

“…Of these 62 patients with tuberculosis of pancreas, 14 (23%) had HIV seropositivity. It has been speculated that tubercular involvement of the pancreas might occur as a result of either direct extension, lymphohematogenous dissemination, reactivation of a previous abdominal focus or immune reaction to generalized tuberculosis [17, 18]. The presence of constitutional symptoms of tuberculosis like fever and anorexia have not been seen in the majority of patients reported.…”

“…Associated findings may include the presence of lymphadenopathy, splenic vein thrombosis, focal hepatic or splenic lesions, bowel thickening in the ileocecal region and ascites [5, 8]. Even the presence of calcification in the gland has been reported in pancreatic tuberculosis [18, 23]. However, none of these morphological features either alone or in combination are pathognomonic of pancreatic tuberculosis, which makes it difficult to differentiate the disorder from pancreatic cancer.…”