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Intraperitoneal Solid Organ Tuberculosis: Our 12-Year Experience. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03602-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Paramasivam S, Murali M, Rajappa P. Obstructed ileocaecal tuberculosis with splenic tuberculosis and solid pseudopapillary tumour of tail of pancreas in an immunocompetent woman. BMJ Case Rep 2020; 13:13/9/e235195. [PMID: 32878854 DOI: 10.1136/bcr-2020-235195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 22-year-old young woman presented with fever, lower abdominal pain and vomiting for 20 days. She had persistent fever and abdominal pain. Fever panel was negative. Clinical features were suggestive of subacute small bowel obstruction. Contrast-enhanced CT abdomen showed thickening of distal ileum, ileocaecal junction and caecum with conglomerate necrotic nodal mass in the ileocolic mesentry along with a lesion in the tail of pancreas. Patient was discussed with multidisciplinary team and decided to undergo a single-stage procedure after adequate nutritional optimisation. During optimisation, she underwent acute obstruction and hence taken up for emergency laparotomy proceeded to right haemicolectomy with distal pancreatectomy and splenectomy 4 weeks after the time of admission. Histopathology showed ileocaecal tuberculosis and solid pseudopapillary tumour with margins free of tumour. Approach of obstructed ileocaecal tuberculosis in the setting of incidental diagnosis of solid pseudopapillary tumour of pancreas in a moribund patient was challenging.
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Affiliation(s)
- Surendran Paramasivam
- General Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Magesh Murali
- General Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - Parimuthukumar Rajappa
- General Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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Ben Hammouda S, Chaka A, Njima M, Korbi I, Zenati H, Zakhama A, Hadhri R, Zouari K. Primary pancreatic tuberculosis mimicking pancreatic body cancer. A case report and review of the literature. Ann Med Surg (Lond) 2020; 58:80-83. [PMID: 32953104 PMCID: PMC7486414 DOI: 10.1016/j.amsu.2020.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/27/2020] [Indexed: 01/23/2023] Open
Abstract
Isolated pancreatic tuberculosis (PT) is an extremely rare disease, with non-specific clinical characteristics, making the diagnosis often challenging with pancreatic cancers. Here we report a case of a 36-year-old female, who was admitted to our hospital after suffering from a 3-month history of epigastric abdominal pain, night sweats and weight loss. The physical examination was normal. The radiological findings revealed the presence of a pancreatic mass and multiple abdominal lymphadenopathy, suggestive of malignancy. The initial differential diagnosis suspected was pancreatic tuberculosis. Tuberculosis skin test was performed and was highly positive (>22 mm). Computed tomography (CT)-guided biopsy of peripancreatic lymph node was carried out and the histopathological exam confirmed the diagnosis of PT. Therefore, anti-tuberculous therapy was initiated, leading to clinical and radiological improvement. The diagnosis of PT is rare and can sometimes be misleading. It should be considered when a pancreatic mass is observed, especially in endemic countries, to ovoid unnecessary interventions. Isolated pancreatic tuberculosis is an extremely rare disease, with non-specific clinical characteristics. Clinical presentation and radiological findings of a pancreatic mass may be suggestive of malignancy. Preoperative microbiological or/and histological diagnosis should be made to avoid the patient unnecessary surgical procedures.
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Affiliation(s)
| | - Amina Chaka
- Department of Digestive Surgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Manel Njima
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Ibtissem Korbi
- Department of Digestive Surgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hanen Zenati
- Department of Digestive Surgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Abdelfatteh Zakhama
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Rim Hadhri
- Department of Pathology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Khadija Zouari
- Department of Digestive Surgery, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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Dong Y, Jürgensen C, Puri R, D'Onofrio M, Hocke M, Wang WP, Atkinson N, Sharma M, Dietrich CF. Ultrasound imaging features of isolated pancreatic tuberculosis. Endosc Ultrasound 2017; 7:119-127. [PMID: 28721972 PMCID: PMC5914183 DOI: 10.4103/2303-9027.210901] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: Isolated pancreatic tuberculosis (PTB) is extremely rare worldwide. The purpose of this multicenter retrospective study is to analyze imaging features of histologically confirmed isolated PTB in order to determine the diagnostic features of the new methods contrast enhanced ultrasound (CEUS), ultrasound elastography and contrast enhanced endoscopic ultrasound (CE-EUS). Patients and Methods: We report on a retrospective data collection of 12 cases of PTB confirmed by histology or cytology. All examinations were interpreted by two independent readers in consensus. CEUS, CE-EUS and ultrasound elastography were performed according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines. Results: In PTB patients the common bile duct was never dilated. Multiple retroperitoneal lymph nodes are the second important B-mode ultrasound feature detected in 75% of PTB patients. CE-EUS was performed in three PTB patients demonstrating hyperenhancement. On elastography, all PTB lesions were markedly stiffer than surrounding pancreatic parenchyma. Conclusions: Here we report the first time on CEUS and elastography features of PTB. PTB had some typical imaging features with iso- or hyperenhancement on CE(E) US. PTB is markedly stiffer on elastography. If clinicians are aware of clinical features of PTB and conduct appropriate investigations with multiple modalities including B-mode ultrasound, CEUS, and EUS guided fine needle aspiration, diagnosis of PTB without laparotomy is possible and the disease can be effectively treated with anti-tuberculous drugs.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - Christian Jürgensen
- Department of Hepatology and Gastroenterology, Charite University, 10117 Berlin, Germany
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - Nathan Atkinson
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, India
| | - Christoph F Dietrich
- Medical Department, Caritas-Krankenhaus, Germany; Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, Germany
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Yamada R, Inoue H, Yoshizawa N, Kitade T, Tano S, Sakuno T, Harada T, Nakamura M, Katsurahara M, Hamada Y, Tanaka K, Horiki N, Takei Y. Peripancreatic Tuberculous Lymphadenitis with Biliary Obstruction Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy. Intern Med 2016; 55:919-23. [PMID: 27086805 DOI: 10.2169/internalmedicine.55.6123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 57-year-old man with a history of tuberculosis (TB) was found to have a pancreatic head mass, accompanied by stenosis of the common bile duct. Due to the inherent difficulty in differentiating pancreatic carcinoma from an inflammatory mass, endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) was thus performed. The pathological findings confirmed granuloma with caseous necrosis, and the results of the QuantiFERON TB2G test were positive. Accordingly, the patient was diagnosed with peripancreatic TB and thereafter was successfully treated with anti-TB therapy. Based on the findings of this case, we conclude that EUS-FNAB is a useful modality for the diagnosis of pancreatic TB.
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Affiliation(s)
- Reiko Yamada
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Japan
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Chaudhary P, Bhadana U, Arora MP. Pancreatic Tuberculosis. Indian J Surg 2015; 77:517-24. [PMID: 26884661 DOI: 10.1007/s12262-015-1318-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 08/05/2015] [Indexed: 12/12/2022] Open
Abstract
Tuberculosis of the pancreas is extremely rare and in most of the cases mimics pancreatic carcinoma. There are a number of case reports on pancreatic tuberculosis with various different presentations, but only a few case series have been published, and most of our knowledge about this disease comes from individual case reports. Patients of pancreatic tuberculosis may remain asymptomatic initially and manifest as an abscess or a mass involving local lymph nodes and usually present with non-specific features. Pancreatic tuberculosis may present with a wide range of imaging findings. It is difficult to diagnose tuberculosis of pancreas on imaging studies as they may present with masses, cystic lesions or abscesses and mass lesions in most of the cases mimic pancreatic carcinoma. As it is a rare entity, it cannot be recommended but suggested that pancreatic tuberculosis should be considered in cases with a large space occupying lesions associated with necrotic peripancreatic lymph nodes and constitutional symptoms. Ultrasonography/computed tomography/endosonography-guided biopsy is the recommended diagnostic technique. Most patients achieve complete cure with standard antituberculous therapy. The aims of this study are to review clinical presentation, diagnostic studies, and management of pancreatic tuberculosis and to present our experience of 5 cases of pancreatic tuberculosis.
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Affiliation(s)
- Poras Chaudhary
- Department of General Surgery, Lady Hardinge Medical College and Associated Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Utsav Bhadana
- Department of General Surgery, Lady Hardinge Medical College and Associated Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Mohinder P Arora
- Department of General Surgery, Lady Hardinge Medical College and Associated Dr Ram Manohar Lohia Hospital, New Delhi, India
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Sun SL, Gao F, Cui DX, Wang BS. Isolated pancreatic tuberculosis in non-immunocompromised patient treated by Whipple's procedure: a case report. ACTA ACUST UNITED AC 2014; 29:58-60. [PMID: 24698682 DOI: 10.1016/s1001-9294(14)60027-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PANCREATIC tuberculosis (TB) is a rare disease and its diagnosis is difficult because of the lack of specific clinical manifestations. Computed tomography (CT) and magnetic resonance imaging (MRI) have some diagnostic values in this disease, but it is easy to misdiagnose pancreatic TB as a pancreatic tumor.1 In this article, we present a case of non-immunocompromised patient developing an isolated pancreatic TB, report the CT and MRI findings, and the surgical procedure for it.
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Affiliation(s)
- Shao-long Sun
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Feng Gao
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Dong-xu Cui
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Bao-sheng Wang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Sotoudehmanesh R, Khatibian M, Zandi A, Shokri-Shirvani J, Yaghoobi A, Sotoudeh M, Mohammadnejad M. Pancreatic Tuberculosis Diagnosed with Endoscopic Ultrasound–Guided Fine Needle Aspiration. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2013. [DOI: 10.1177/8756479313476917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pancreatic tuberculosis is very rare, especially in immunocompetent patients, and represents a diagnostic challenge. The clinical features in patients with pancreatic tuberculosis are usually nonspecific, and the radiologic features may mimic pancreatic malignancy or pancreatitis. We describe four cases with pancreatic tuberculosis mimicking carcinoma or pancreatic cyst on imaging. None of these patients was immunocompromised. Endoscopic ultrasound–guided fine needle aspiration demonstrated necrotizing granulomatous inflammation in these cases and acid-fast bacilli in two of them. We suggest that pancreatic tuberculosis should be included in the differential diagnosis of a pancreatic cystic or solid-cystic mass, especially in patients from a region where tuberculosis is endemic.
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Affiliation(s)
- Rasoul Sotoudehmanesh
- Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Morteza Khatibian
- Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | | | | | - Ali Yaghoobi
- Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Masood Sotoudeh
- Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
| | - Mehdi Mohammadnejad
- Digestive Disease Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
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Huang CT, Lo CY, Lee TH. Isolated peripancreatic tuberculous lymphadenopathy: a rare manifestation of abdominal tuberculosis mimicking pancreatic cystic neoplasm. J Dig Dis 2013; 14:105-8. [PMID: 23121697 DOI: 10.1111/1751-2980.12011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Chung-Tsui Huang
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, China
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Patel D, Loren D, Kowalski T, Siddiqui AA. Pancreatic tuberculosis mimicking malignancy diagnosed with endoscopic ultrasound-guided fine needle aspiration. Endosc Ultrasound 2013; 2:38-40. [PMID: 24949364 PMCID: PMC4062235 DOI: 10.7178/eus.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 01/03/2013] [Indexed: 11/20/2022] Open
Abstract
A female presented to the physician with a history of right upper quadrant pain. Abdominal computed tomography (CT) scan dem-onstrated a multi-loculated solid lesion in the head of the pancreas concerning for a primary malignancy. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of the lesion was performed and cytology revealed no evidence of malignancy. The acid-fast bacilli culture was found to be positive for Mycobacterium tuberculosis complex and pancreatic tuberculosis was diagnosed.
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Affiliation(s)
- Devi Patel
- Division of Gastroenterology and Hepatology, Department of Internal Medicine1, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - David Loren
- Division of Gastroenterology and Hepatology, Department of Internal Medicine1, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Thomas Kowalski
- Division of Gastroenterology and Hepatology, Department of Internal Medicine1, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Ali A Siddiqui
- Division of Gastroenterology and Hepatology, Department of Internal Medicine1, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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11
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Tuberculous lymphadenopathy mimicking pancreatic neoplasm. Case Rep Med 2012; 2012:579297. [PMID: 22851977 PMCID: PMC3407625 DOI: 10.1155/2012/579297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 06/25/2012] [Accepted: 06/26/2012] [Indexed: 02/03/2023] Open
Abstract
Abdominal tuberculosis (TB) is the sixth most common location of extrapulmonary TB involvement. Because its symptoms and signs are often nonspecific, laboratory and imaging findings mimic other diseases including carcinoma. Therefore, the diagnosis of abdominal TB is challenging. We herein report a case of 74-year-old woman who presented with abdominal pain, anorexia, and weight loss. She had been given a diagnosis of pancreatic head carcinoma. Laboratory data was unremarkable except for elevated erythrocyte sedimentation rate, CA125, and sIL-2R. CT scan revealed multiple enlarged peripancreatic lymph nodes and concentric thickening of the ileocecal wall. Colonoscopy demonstrated deformed ileocecal valve and erosions. Histological examination showed epithelioid granulomas. Laparoscopy revealed numerous white tubercles diffusely covering the parietal peritoneum. Histopathological images of peripancreatic lymph node revealed large multiple caseating granulomas surrounded by Langhans_giant cells and epithelioid cells. Polymerase chain reaction and culture of the specimens were positive for Mycobacterium tuberculosis. Tuberculous lymphadenopathy, colitis, and peritonitis were finally diagnosed. She responded well to the antitubercular treatment.
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12
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Puri R, Thandassery RB, Eloubeidi MA, Sud R. Diagnosis of isolated pancreatic tuberculosis: the role of EUS-guided FNA cytology. Gastrointest Endosc 2012; 75:900-4. [PMID: 22440205 DOI: 10.1016/j.gie.2011.12.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 12/07/2011] [Indexed: 02/08/2023]
Affiliation(s)
- Rajesh Puri
- Medanta Institute of Digestive and Hepatobiliary Sciences, Medanta--The Medicity, Gurgaon, Haryana, India
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Rana SS, Bhasin DK, Srinivasan R, Sampath S, Mittal BR, Singh K. Distinctive endoscopic ultrasound features of isolated pancreatic tuberculosis and requirements for biliary stenting. Clin Gastroenterol Hepatol 2012; 10:323-5. [PMID: 22037426 DOI: 10.1016/j.cgh.2011.10.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2011] [Revised: 09/29/2011] [Accepted: 10/12/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There are insufficient data about the appearance of isolated pancreatic tuberculosis on endoscopic ultrasound (EUS). The safety and efficacy of antitubercular therapy (ATT) in patients with pancreatic tuberculosis with cholestasis are also relatively unknown. METHODS We evaluated 6 patients with isolated pancreatic head tuberculosis retrospectively and compared their EUS findings with those of 25 patients with pancreatic head adenocarcinoma. RESULTS There was no difference in the EUS appearance between the 2 diseases. The mean diameter of the common bile duct was significantly greater in patients with pancreatic adenocarcinoma. The pancreatic duct was dilated in 20 of 25 patients with pancreatic adenocarcinoma (80%), whereas it was dilated in only 1 of 6 patients with pancreatic tuberculosis (16.6%) (P < .05). All 6 patients with pancreatic tuberculosis had a resolution of their cholestatic symptoms within 4 weeks of starting ATT alone. None of these patients required biliary stenting. CONCLUSIONS None of the EUS features of a mass lesion caused by pancreatic tuberculosis are distinctive. Once diagnosed, these patients can be successfully treated with ATT without needing biliary stenting.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
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Abstract
BACKGROUND Tuberculosis (TB) and malignancy represent global threats claiming millions of lives and inflicting formidable suffering worldwide. Surprisingly, the pathophysiological and practical implications of their co-existence have received little attention. METHODS Therefore, we sought to review the available literature on the field and identify data regarding the association between TB and malignancy in order to highlight the neglected aspects of this association and probably derive clinically useful information. We searched PubMed up to June 2008 for case reports, case series, non-comparative and comparative studies that were written in English and reported data on the occurrence of both TB infection and a neoplastic disorder in the same patient(s). The development of mycobacterial infections in patients with immunocompromized conditions is well known and was considered outside the scope of this review. EVIDENCE SYNTHESIS The synthesis of the available evidence enabled us to establish three different types of association between malignancy and TB: (i) the development of cancer on the background of a previous tuberculous infection; (ii) the concurrent existence of TB and malignancy in the same patient(s) or clinical specimen(s); and (iii) the diagnostic challenges arising from the multi-faceted presentations of these two disorders. CONCLUSION We conclude that clinicians need to be aware of the protean manifestations of TB and cancer and maintain a high index of suspicion for simultaneous and/or misleading presentations. In addition, further research is required to determine if a tuberculous infection, being similar to other chronic infections and inflammatory conditions, may facilitate carcinogenesis.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences, 9 Neapoleos Street, 151 23 Marousi, Greece.
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15
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Karaca G, Pirti O, Güler O, Köklü S. Isolated pancreatic tuberculosis in a patient with total situs inversus. Am J Gastroenterol 2009; 104:2650-1. [PMID: 19806112 DOI: 10.1038/ajg.2009.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Song TJ, Lee SS, Park DH, Lee TY, Lee SO, Seo DW, Lee SK, Kim MH. Yield of EUS-guided FNA on the diagnosis of pancreatic/peripancreatic tuberculosis. Gastrointest Endosc 2009; 69:484-91. [PMID: 19231490 DOI: 10.1016/j.gie.2008.10.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 10/06/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pancreatic/peripancreatic tuberculosis (TB) is a very rare clinical entity, even in countries with high incidences of TB. The diagnosis of pancreatic/peripancreatic TB with EUS-guided FNA (EUS-FNA) remains a diagnostic challenge because of limitations of the endoscopists' expertise on this condition. OBJECTIVE This study evaluated the yield and usefulness of EUS-FNA in patients with pancreatic/peripancreatic TB. DESIGN A retrospective analysis was performed. SETTING A tertiary teaching hospital in Seoul, Korea. PATIENTS Baseline demographic and clinical features were evaluated in 21 consecutive patients with pancreatic/peripancreatic TB who underwent EUS-FNA between September 2003 and April 2007. RESULTS The mean lesion diameter was 31.3 +/- 14.6 mm. Thirteen patients (61.9%) showed granulomatous inflammation on histopathologic examination, and 10 of 15 patients (66.7%) were positive on a TB polymerase chain reaction assay. Ziehl-Neelsen staining was positive in 4 of 15 patients (26.7%), and 3 of 8 patients (37.5%) had cultures positive for Mycobacterium tuberculosis. EUS-FNA correctly diagnosed pancreatic/peripancreatic TB in 16 patients (76.2%). Therefore, unnecessary surgery was avoided for these patients. LIMITATION A retrospective study. CONCLUSIONS EUS-FNA is a safe and promising method for the diagnosis of pancreatic/peripancreatic TB. Use of this method may help us to avoid the use of surgery and provide timely and accurate diagnosis.
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Affiliation(s)
- Tae Jun Song
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Chang WC, Chu HC, Tsai SH, Huang GS, Cheng MF, Yu CY. An extraordinary presentation. Am J Med 2009; 122:245-7. [PMID: 19272485 DOI: 10.1016/j.amjmed.2008.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
Affiliation(s)
- Wei-Chou Chang
- Department of Radiology, Division of Gastroenterology and Hepatology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, Republic of China
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18
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Abid M, Guirat A, Ayadi L, Mzali R, Ben Amar M, Beyrouti MI. Pancreatic tuberculosis: a rare cause of pseudoneoplasic obstructive jaundice. Presse Med 2009; 38:e7-e10. [PMID: 19167862 DOI: 10.1016/j.lpm.2008.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Revised: 09/08/2008] [Accepted: 09/15/2008] [Indexed: 12/31/2022] Open
Affiliation(s)
- Mohamed Abid
- General surgery department, CHU Habib Bourguiba, 3029 Sfax, Tunisia.
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19
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Ikeura T, Takaoka M, Shimatani M, Koyabu M, Kusuda T, Suzuki R, Sumimoto K, Okazaki K. Xanthogranulomatous inflammation of the peripancreatic region mimicking pancreatic cystic neoplasm. Intern Med 2009; 48:1881-4. [PMID: 19881238 DOI: 10.2169/internalmedicine.48.2088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Xanthogranulomatous inflammation (XGI) is histopathologically characterized by a marked proliferative fibrosis, parenchymal destruction, and infiltration of foamy histiocytes intermixed with other inflammatory cells. Herein, we report a case of a 73-year-old man without symptoms who was initially diagnosed with a pancreatic cystic tumor but later with XGI in the peripancreatic region. Although XGI has been reported to occur in various organs or tissues, such as the gallbladder, kidney, bone, stomach, colon, appendix, lymph nodes, and soft tissues, XGI involving the pancreas or its surrounding tissues is extremely rare. When a pancreatic cystic lesion does not have typical clinicoradiological features of common pancreatic cystic neoplasms, this pathologic condition should be considered in the differential diagnosis.
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Affiliation(s)
- Tsukasa Ikeura
- The Third Department of Internal Medicine, Kansai Medical University, OSAka, Japan.
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Rong Y, Lou W, Jin D. Pancreatic tuberculosis with splenic tuberculosis mimicking advanced pancreatic cancer with splenic metastasizes: a case report. CASES JOURNAL 2008; 1:84. [PMID: 18694521 PMCID: PMC2527492 DOI: 10.1186/1757-1626-1-84] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 08/12/2008] [Indexed: 11/16/2022]
Abstract
A 60-year-old woman presented with vague abdominal pain for one week was referred to pancreatic tail carcinoma accompanied with splenic metastasizes. She came to our hospital for further treatment. Ultrasonography and abdominal computed tomography (CT) revealed a pancreatic tail tumor with splenic metastasizes. There was no history of tuberculosis. Laparotomy was performed because pancreatic tail carcinoma with splenic metastasizes was highly suspected. Indurated mass in the pancreatic tail and sporadic metastasizes in the spleen had been found during the surgery. The pancreatic tail and the spleen were removed and proved to be tuberculosis on histological examination of a frozen section. The patient was given antituberculosis therapy and is now getting well. Tuberculosis should be considered in the differential diagnosis of pancreatic masses. The response to antituberculosis treatment is very favorable.
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Affiliation(s)
- Yf Rong
- Pancreatic Group, Department of General surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, PR China.
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Borentain P, Grandval P, Ananian P, Meunier-Carpentier S, Gérolami R, Escoffier JM, Durand JM, Botta-Fridlund D, Bernardini D. [Pancreatic tuberculosis: an unusual cause of obstructive jaundice accessible to endoscopic management]. ACTA ACUST UNITED AC 2008; 31:1024-7. [PMID: 18166900 DOI: 10.1016/s0399-8320(07)78325-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Tuberculosis of the pancreas is unusual and often secondary to generalized tuberculosis. In most cases clinical presentation is obstructive jaundice due to pancreatic mass lesion. Although diagnosis is usually obtained after resection of the mass lesion, endoscopic procedures might avoid non-necessary surgical procedure. We report a clinical case of pancreatic tuberculosis diagnosed by endoscopic ultrasound guided fine needle aspiration biopsy and treated by biliary stenting.
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Affiliation(s)
- Patrick Borentain
- (1) Service d'hépatogastroentérologie, Hôpital de la Conception, Marseille.
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Khurana A, Rekhi B, Kane SV, Shukla P, Ramadwar M. Pancreatic tuberculosis masquerading as pancreatic carcinoma in two cases: role of fine needle aspiration cytology in diagnosis. Cytopathology 2007; 18:380-3. [DOI: 10.1111/j.1365-2303.2007.00535.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Charrada-Ben Farhat L, Ben Yaâcoub I, Hamzaoui S, Gharbi L, Dali N, Ben Dridi M, Hendaoui L. Aspects radiocliniques trompeurs de la tuberculose abdominale. ACTA ACUST UNITED AC 2007; 88:1729-32. [DOI: 10.1016/s0221-0363(07)74054-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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24
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Nakai Y, Tsujino T, Kawabe T, Kogure H, Sasaki T, Yamamoto N, Sasahira N, Isayama H, Tada M, Omata M. Pancreatic tuberculosis with a pancreaticobiliary fistula. Dig Dis Sci 2007; 52:1225-8. [PMID: 17372824 DOI: 10.1007/s10620-006-9471-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Accepted: 05/31/2006] [Indexed: 12/09/2022]
Abstract
Pancreatic tuberculosis (TB) is a rare condition that is sometimes difficult to differentiate from pancreatic cancer or other malignancies. A 75-year-old man was admitted to our hospital because of weight loss, fever, and diarrhea. Abdominal ultrasonography and computed tomography (CT) revealed a 3-cm mass in the pancreas head with abdominal lymphadenopathy. Endoscopic retrograde cholangiopancreatography did not show pancreatic duct stenosis or dilatation, but a pancreaticobiliary fistula was demonstrated. Cytological and bacteriological examinations of the pancreatic juice and bile were negative. Endoscopic ultrasonography-guided fine needle aspiration of the mass was not diagnostic. Colonoscopic features and biopsy specimens affirmed the diagnosis of TB, and treatment with antitubercular drugs was started. The pancreatic mass disappeared within 8 weeks and the pancreaticobiliary fistula resolved.
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Affiliation(s)
- Yousuke Nakai
- Department of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Itaba S, Yoshinaga S, Nakamura K, Mizutani T, Honda K, Takayanagi R, Yamada K. Endoscopic ultrasound-guided fine-needle aspiration for the diagnosis of peripancreatic tuberculous lymphadenitis. J Gastroenterol 2007; 42:83-6. [PMID: 17322998 DOI: 10.1007/s00535-006-1913-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2006] [Accepted: 09/12/2006] [Indexed: 02/04/2023]
Abstract
The percentage of patients with atypical extrapulmonary forms of tuberculosis has been increasing. Among extrapulmonary tuberculosis cases, tuberculosis of the pancreas and peripancreatic lymph nodes is a rare clinical entity. Here, we present a case of peripancreatic tuberculous lymphadenitis diagnosed by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) both cytologically and microbiologically. A 23-year-old man had a 1-week history of epigastralgia and low-grade fever. Subsequently, he was found to have an abnormality on abdominal ultrasound. A computed tomography scan of the abdomen showed a solitary mass consisting of multiple cystic components with rim enhancement in the peripancreatic portion contiguous to the gall bladder. Endoscopic ultrasound-guided fine-needle aspiration was performed to confirm the diagnosis. The cytological examination revealed epithelioid cells with caseous necrosis, indicating tuberculosis. The aspirated fluid was positive by polymerase chain reaction (PCR) analysis and culture for Mycobacterium tuberculosis. Antituberculosis therapy with isoniazid, rifampicin, ethambutol, and pyrazinamide was started based on the PCR and cytology results, and a good response to the treatment was noted. Endoscopic ultrasound-guided fine-needle aspiration cytology with PCR analysis is very useful for the diagnosis of peripancreatic tuberculosis.
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Affiliation(s)
- Soichi Itaba
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Cheng R, Grieco VS, Shuhart MC, Rulyak SJ. EUS-guided FNA diagnosis of pancreatic tuberculosis. Gastrointest Endosc 2006; 64:660-3. [PMID: 16996371 DOI: 10.1016/j.gie.2006.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Accepted: 04/10/2006] [Indexed: 12/10/2022]
Affiliation(s)
- Raymond Cheng
- Department of Medicine, University of Washington, Seattle, Washington 98104, USA
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