ABSTRACT
Background: Pancreatic tuberculosis is relatively rare in clinical practice, its clinical symptoms and imaging findings are lack of specificity, and is easily confused with pancreatic benign and malignant tumors. Aims: To summarize the clinical characteristics of pancreatic tuberculosis. Methods: Data of 19 patients with pancreatic tuberculosis from April 2010 to June 2019 at Xijing Hospital of Digestive Diseases, Air Force Medical University were retrospectively analyzed. Results: Among the 19 patients with pancreatic tuberculosis, 11 were male and 8 were female, median age was 33 years old. Clinical manifestations were mainly abdominal pain or upper abdominal discomfort, fever, night sweat, etc. Laboratory tests showed anemia in 11 patients, increased erythrocyte sedimentation rate in 13 patients, increased amylase in 7 patients, positive T-spot in 9 patients, positive PPD skin test in 3 patients and elevated bilirubin in 5 patients. Imaging examination showed that pancreatic tuberculosis was mainly located in pancreatic head. Ultrasound of the abdomen showed pancreatic mass, changes of internal echo in 8 patients, and pancreatic cystic or solid mass in 11 patients. CT showed significant enlargement of pancreatic head in 5 patients, solid pancreatic occupying lesion in 7 patients, cystic pancreatic occupying lesion in 4 patients, and enlargement of peripancreatic, mesenteric or retroperitoneal lymph nodes in 6 patients. Fourteen endoscopic ultrasound-guided fine-needle aspiration biopsy were performed in 8 patients; 5 patients underwent ultrasound-guided percutaneous biopsy of the occupying lesion. All the patients were given regular anti-tuberculosis treatment, and no relapse was found during the follow-up. Conclusions: For young patients with pancreatic space-occupying lesion, the possibility of pancreatic tuberculosis should be considered. Biopsy is still the current method of diagnosis, and regular anti-tuberculosis treatment is the main treatment for pancreatic tuberculosis.
ABSTRACT
A 24-year-old male patient presented with abdominal pain, obstructive jaundice, anorexia and weight loss. Ultrasound abdomen revealed pancreatic head mass with dilated common hepatic duct and intrahepatic bliliary radicles. CECT abdomen was suggestive of pancreatic head mass invading portal vein, splenic artery and hepatic artery. Provisional diagnosis of unresectable carcinoma head of pancreas was established. Endoscopic ultrasound (EUS) was done, which was also suggestive of pancreatic head mass infiltrating portal vein. EUS guided Fine Needle Aspiration Cytology (FNAC) was taken with an intent to obtain tissue diagnosis and to start palliative chemotherapy. EUS guided FNAC features were suggestive of tuberculosis (TB). Patient was started on anti-tubercular therapy, to which he responded and was cured. Pancreatic tuberculosis should be considered as a possibility, in pancreatic mass, especially in countries where TB is endemic and establishing its diagnosis with the aid of FNAC can save trauma of major surgery to the patient, which prompted us to report this case.
ABSTRACT
Pancreatic tuberculosis (TB) is extremely rare and mimics pancreatic carcinoma both clinically and radiologically. This paper discusses the occurrence of 2 heterogeneous masses located in the head and tail of the pancreas in an adult male. In this patient, laparotomy was performed because of the high suspicion of pancreatic carcinoma. Intraoperative fine needle aspiration biopsy revealed the coexistence of pancreatic carcinoma with pancreatic TB, and a combined resection of the distal pancreas and spleen was successfully performed. Following surgery, the patient received standard chemotherapy for TB. At 7-month follow-up, computed tomography showed resolution of the mass in the pancreatic head. Clinicians must maintain a high index of suspicion for pancreatic TB in patients with pancreatic masses. The coexistence of malignancy and TB should be considered when patients present with multiple pancreatic masses.
Subject(s)
Adult , Humans , Male , Biopsy , Biopsy, Fine-Needle , Follow-Up Studies , Head , Laparotomy , Pancreas , Pancreatic Neoplasms , Spleen , TuberculosisABSTRACT
Isolated pancreatic tuberculosis (TB) is extremely rare, even in countries where TB is endemic. The recent increased reporting of TB of the pancreas is related to a worldwide increase in TB and an increase in emigration from countries where TB is endemic into countries where more sophisticated healthcare and diagnostic facilities are available. Herein, we report an unusual case of isolated pancreatic region TB, which presented with dyspeptic symptoms and was diagnosed by ultrasonography-guided needle aspiration and computed tomography scan of the abdomen. This case is unique with regard to abundant bacterial load, as evident by Ziehl Neelsen staining and absence of evidence of TB elsewhere. Pancreatic TB should be considered as a differential diagnosis of a pancreatic mass and most patients have an excellent clinical response to standard antituberculosis regimens.
ABSTRACT
A 51-year old man presented with generalized edema for 10 days. He was admitted to the hospital for a renal biopsy, and a pancreatic mass was incidentally detected by ultrasonography. The renal biopsy was consistent with membranous glomerulonephritis and the pancreas biopsy revealed chronic granulomatous inflammation with multinucleated giant cells, which was suggestive of tuberculosis of the pancreas. The patient was initially treated with a steroid and anti-tuberculosis drugs, but the proteinuria in the nephrotic range persisted throughout the 3-month follow-up. With the presumed diagnosis of tuberculosis-induced membranous nephropathy, immunosuppressant therapy was stopped and anti-tuberculosis drugs were administered for 31 months. With anti-tuberculous treatment, the proteinuria was reduced from 22 g/day to 0.57 g/day. A follow-up abdominal CT revealed a marked reduction in the size of the pancreatic mass. This finding suggests that the membranous nephropathy in our case was related to the pancreatic tuberculosis rather than it being related to primary nephrotic syndrome.
Subject(s)
Humans , Biopsy , Edema , Follow-Up Studies , Giant Cells , Glomerulonephritis, Membranous , Inflammation , Nephrotic Syndrome , Pancreas , Proteinuria , TuberculosisABSTRACT
Systemic manifestation of tuberculosis is common, but tuberculous biliary obstruction of the pancreas and a colon adenocarcinoma with combined colonic tuberculosis is an uncommon disorder. We encountered a case of the above condition in 63-year-old male that was admitted to our hospital because of fever, diffuse abdominal pain and rigidity. Abdominal computed tomography showed biliary and pancreatic duct dilatation with left colonic wall thickening and surrounding peritoneal infiltration. Emergency segmental resection of the descending colon with intraoperative T-tube choledochostomy was performed due to the colon mass and biliary obstruction. A colonofiberoscopy was performed for low abdominal pain and hematochezia at 12 days after surgery. It showed multiple colonic ulcerations with a partial stricture. A colonic biopsy showed granulomatous inflammation with acid-fast bacilli. The cause of the biliary obstruction was also revealed as pancreatic tuberculosis by an intraoperative pancreatic and mesenteric biopsy. The patient improved after antituberculous treatment and the patient has been in good health until the last outpatient follow-up visit.
Subject(s)
Humans , Male , Middle Aged , Abdominal Pain , Adenocarcinoma , Biopsy , Choledochostomy , Colitis , Colon , Colon, Descending , Colonic Neoplasms , Constriction, Pathologic , Dilatation , Emergencies , Fever , Follow-Up Studies , Gastrointestinal Hemorrhage , Inflammation , Outpatients , Pancreas , Pancreatic Ducts , Tuberculosis , UlcerABSTRACT
Tuberculosis of the pancreas is a rare disorder. The clinical presentation of pancreatic tuberculosis include nonspecific symptoms such as fever, fatigue and weight loss. The radiological features mimic pancreatic malignancy or pancreatitis. So, the diagnosis of pancreatic tuberculosis is very difficult. A 62-year-old man was referred for pancreatic mass. Findings on preoperative imaging modalities were consistent with pancreatic carcinoma, and fine needle aspiration test indicated microcystic adenoma or carcinoma. Pylorus-preserving pancreaticoduodenectomy was done. Final diagnosis was pancreatic tuberculosis combined with microcystic adenoma. We conclude in that patients who have a mass in the pancreas, pancreatic tuberculosis should be considered, particularly in the developing country and immunosuppressed individuals.
Subject(s)
Humans , Middle Aged , Adenoma , Biopsy, Fine-Needle , Developing Countries , Diagnosis , Fatigue , Fever , Pancreas , Pancreaticoduodenectomy , Pancreatitis , Pancrelipase , Tuberculosis , Weight LossABSTRACT
Tuberculosis is an extremely common chronic disease in developing countries, caused by Mycobacterium tuberculosis. The principal target organ is the lung, causing focal necrosis and destruction. In about 12 percent of cases, extrapulmonary dissemination involving the gastrointestinal system occurs. The pancreas is involved in about 0,25 percent of all cases of disseminated tuberculosis, but its isolated involvement is a medical curiosity. In the last years, with the advent of AIDS, extrapulmonary dissemination and atypical abdominal presentation has increased. We report a case of pancreatic tuberculosis in a 66-year-old patient, with no previous history of pulmonary tuberculosis or immunocompromised state in whom the diagnosis was made by CT-guided skin needle biopsy. After clinical treatment with current antibiotic therapy, the patient recovered well.