Journal List > Korean J Gastroenterol > v.53(5) > 1006551

Cho: Pancreatic Tuberculosis Presenting with Pancreatic Cystic Tumor: A Case Report and Review of the Literature

Abstract

Pancreatic tuberculosis is a rare clinical entity, presenting as malignancy mimicking pancreatic mass. Therefore, it represents a diagnostic challenge. To date, ten cases have been reported in Korea. I report an additional case and review all Korean reports about pancreatic tuberculosis. A 57-year-old woman presented with abdominal pain. Abdominal computed tomography (CT) revealed a 2.2×1.2 cm cystic mass in pancreatic body. She was followed for nine months, at which time a cystic mass was enlarged to 3.3×2.2 cm in size on the CT. An exploratory laparotomy was performed for the accurate diagnosis and to rule out the possibility of malignant change. Pathological examination of the resected specimen revealed chronic granulomatous inflammation with caseous necrosis and multinucleated giant cells, which was compatible with tuberculosis. Among the 11 cases of pancreatic tuberculosis, five cases were combined with pulmonary tuberculosis. The pancreatic tuberculosis frequently presented with multicystic pancreatic mass (81%) and the most common anatomic locations were the head (73%), tail (18%), and body (9%). Three cases were diagnosed by using US or EUS guided fine needle aspiration biopsy (FNAB), and all cases were medically cured without exploratory laparotomy. In summary, pancreatic tuberculosis, despite its rarity, should be considered for differential diagnosis of pancreatic cystic mass in endemic countries. Clinical suspicion and accurate diagnostic approach including FNAB of pancreatic tuberculosis are need-ed to avoid performing unnecessary laparotomy.

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Fig. 1.
Abdominal CT finding revealed a 2.2×1.2 cm cystic mass in the pancreas body (arrow).
kjg-53-324f1.tif
Fig. 2.
Follow-up abdominal CT finding 9 months after initial CT. It revealed a 3.3×2.2 cm cystic mass in the same area (arrow).
kjg-53-324f2.tif
Fig. 3.
The microscopic finding of resected specimen revealed chronic granulomatous inflammation with caseous necrosis and multinucleated giant cells (H&E stain, ×200).
kjg-53-324f3.tif
Table 1.
Summary of Reported Cases of Pancreatic Tuberculosis in Korea
Case No. Author Age (yrs)/ sex Presenting symptoms Tuberculosis Location Mass nature LAP PD Presumed diagnosis Confirmational diagnosis Anti-tuber-culous treatment Duration Outcome
1 Ko et al6 29/M Jaundice Pulmonary Head N/A N/A Pancreatic cancer Laparotomy with biopsy INH, PAS, SM N/A Well
2 Choi et al7 50/F Weight loss Tail Cystic Occlusion Pancreatic cancer FNAB INH, RIP, SM 12 months Well
3 Park et al8 54/M Abdominal pain Head Cystic Dilation Pancreatic cancer Laparotomy with biopsy INH, RIP, EM N/A Well
4 Lee et al9 34/F Incidental Tail Cystic Normal Pancreatic cancer Laparotomy with biopsy INH, RIP, PZA, EM N/A Well
5 Park et al10 54/M Jaundice Pulmonary Head Cystic Dilation Pancreatic cancer Laparotomy with biopsy N/A Well
6 Park et al10 51/M Weight loss Head Cystic Normal Pancreatic cancer FNAB N/A Well
7 Park et al11 41/F Abdominal pain Head Cystic Normal Pancreatic cancer FNAB INH, RIP, PZA, EM N/A Well
8 Yoo et al12 28/M Jaundice Pulmonary Head Cystic Dilatation Pancreatic cancer Laparotomy with biopsy N/A Well
9 Lee et al13 62/M Palpable mass Pulmonary Head Cystic Dilation Pancreatic cancer Laparotomy with biopsy INH, RIP, PZA, EM N/A Well
10 Hwang et al14 63/M Abdominal pain Pulmonary, Colon Head N/A Dilation Pancreatic cancer Laparotomy with biopsy N/A Well
11 Present case 57/F Incidental Body Cystic Normal Pancreatic cancer Laparotomy with biopsy INH, RIP, EM 12 months Well

LAP, lymphadenopathy; PD, pancreatic duct; N/A, not available; INH, isonizide; RIP, rifampin; PZA, pyrazinamide; SM, streptomycin; EM, ethambutol; PAS, para-aminosalicylic acid.

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