Pancreatic tuberculosis: an elusive diagnosis.

BACKGROUND: Pancreatic tuberculosis is a rare disease. Its presenting features are usually vague and non-specific, while the radiological features mimic pancreatic malignancy in many cases and pancreatitis in others. Ultrasound- or CT-guided fine-needle aspiration cytology (FNAC) or biopsy may show caseating granulomatous inflammation but microbiological confirmation may not always be possible. Laparotomy may be required if other investigations prove inconclusive. The response to treatment is good. CASE OUTLINES: We report two young men with pancreatic tuberculosis. The diagnosis was obtained by FNAC in one and laparotomy in the other. Each patient responded to anti-tuberculous chemotherapy and is now asymptomatic. CONCLUSION: Tuberculosis should be considered in the differential diagnosis of an obscure pancreatic mass, and the condition is readily curable.

Pancreatic tuberculosis.

Tuberculosis infrequently involves pancreas. The clinical features in patients with pancreatic tuberculosis are usually non-specific. The radiological features mimic pancreatic malignancy or pancreatitis. Ultrasound or CT scan guided fine needle aspiration cytology or biopsy may show caseating granulomatous inflammation. The present report includes two cases of pancreatic tuberculosis and review of relevant literature. One of our patients was diagnosed at laparotomy and the other with a CT scan guided fine needle aspiration cytology. Both patients responded well to anti tubercular chemotherapy and are now asymptomatic.

Inflammatory pseudotumor of the esophagus.

Inflammatory pseudotumors of the esophagus are uncommon. They pose diagnostic and therapeutic dilemmas, especially when located in the cervical esophagus. History and physical examination are rarely contributory. Routine radiologic investigations including barium swallow and computed tomography only raise the suspicion of a benign esophageal neoplasm. Esophagoscopy and biopsy do not provide a definite diagnosis, as these 'tumors' are frequently submucosal, unless they enlarge sufficiently to cause mucosal ulcerations. Endoscopic ultrasonography may accurately localize the tumor but is not diagnostic. Conservative surgical resection or debulking would be both diagnostic and therapeutic. Steroids, cyclophosphamide and low-dose radiotherapy may at best be considered second-line therapy. One such case of inflammatory pseudotumor of the cervical esophagus is presented and the relevant literature is reviewed. Our patient could not be diagnosed on preoperative investigations and required an esophagotomy with frozen section. We debulked the mass and the patient is asymptomatic 6 months after surgery.