EUS-guided FNA diagnosis of pancreatic tuberculosis

Peripancreatic Tuberculous Lymphadenitis with Biliary Obstruction Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy

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.

Endoscopic ultrasound guided fine needle aspiration for diagnosis of pancreatic tuberculosis: Report of one case

The incidence of pancreatic tuberculosis is low. Pancreatic tuberculosis often presents as a pancreatic mass. If patients have no history of tuberculosis, pancreatic tuberculosis is often misdiagnosed as a pancreatic tumor. Only after surgery it can be diagnosed correctly. Endoscopic ultrasonography guided fine needle aspiration (EUS-FNA) allows for biopsy of pancreatic tissue to conduct pathological examination, thus providing clinical evidence for the diagnosis of pancreas diseases. Compared with ultrasound and CT guided puncture, EUS-FNA has advantages of high accuracy and fewer complications.

Peripancreatic tuberculous lymphadenopathy masquerading as pancreatic malignancy: a single-center experience

BACKGROUND AND AIM

Peripancreatic tuberculous lymphadenopathy is very rare and can be misdiagnosed with pancreatic or peripancreatic malignancies. The clinical characteristics and treatment outcome have not been well known. Herein, we investigated the accuracy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA), clinical features, and treatment outcomes.

METHODS

We retrospectively analyzed 42 patients diagnosed with peripancreatic tuberculosis between December 2004 and January 2011 at the tertiary care hospital in Korea.

RESULTS

Median age was 36 years (interquartile range, 30-55), and female was 66.7% (28/42). Nineteen patients (45.2%) had no symptoms, while the others had non-specific various symptoms. Thirteen (31.0%) had a previous history of tuberculosis. Initial impressions of the mass were pancreatic cancer in 14 (33.3%) and tuberculous lymphadenopathy in 13 patients (31.0%). EUS-FNA was performed in all 42 patients, with a diagnostic yield of pathologic examinations in 80.5%, polymerase chain reaction for tuberculosis in 42.9%, culture in 47.4%, and acid-fast bacilli staining in 10.0%. Tuberculosis is confirmed in 28 (66.7%), and probable tuberculosis in 14 (33.3%). All patients received anti-tuberculosis treatment, a 6-months regimen in 12 (28.6%) and a 9-months regimen in 28 (66.7%). Treatment response evaluated in 35 patients (83.3%) by computed tomography criteria showed complete response in 10 patients (28.6%), partial response in 23 (65.7%), stable disease in 1 (2.9%), and progressive disease in 1 (2.9%).

CONCLUSIONS

Peripancreatic tuberculous lymphadenopathy is frequently mistaken for pancreatic malignancy. EUS-FNA can be helpful for an accurate diagnosis. Complete resolution of the lesion, however, was not common on following imaging study after treatment.

The utility of endoscopic ultrasound guided fine needle aspiration in the diagnosis of infectious diseases-report of three cases

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a fast and minimally invasive methodology with a crucial impact on patients' management. It has an important and established role in the diagnosis and staging of mediastinal and abdominal malignancies, but little is discussed in the literature on the usefulness of this technique in the diagnosis of infectious diseases. In the current report, we present three different cases where EUS was essential for reaching the diagnosis of tuberculosis and paracoccidiodomicosis in cases otherwise seen as malignant. In conclusion, EUS was successful not only in obtaining enough cells for morphological analysis, but also for the production of cell blocks and assessment of the presence of the microorganisms by special stains. EUS allied to fine needle biopsy was an important tool in determining diagnoses of enlarged lymph nodes, revealing the diagnosis of infectious diseases in cases otherwise seen as malignant. The wide use of this methodology in cases such as those reported here cannot only rule out malignancy, but also aid critically ill patients by installing early proper therapy without the need for aggressive interventions.

Pancreatic tuberculosis mimicking malignancy diagnosed with endoscopic ultrasound-guided fine needle aspiration

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.

Solitary pancreatic tuberculosis: A case report and literature review

AIM: To analyze the clinical characteristics of and diagnostic methods for solitary pancreatic tuberculosis.

METHODS: A case of solitary pancreatic tuberculosis was reported. In addition, 48 similar cases in published Chinese literature were identified to conduct a literature review. The data were identified by searching CNKI and CBM databases and browsing the relevant reference lists. The keywords were "pancreatic tuberculosis" and "tuberculosis and pancreas". The clinical manifestations were analyzed by descriptive methods. Criteria for the diagnosis of solitary pancreatic tuberculosis were: all lesions localized only in the pancreas and neighboring tissues, no other detectable foci of tuberculosis, no history of tuberculosis, having a clear chest radiograph, and a positive histological diagnosis.

RESULTS: Predominant symptoms consisted of abdominal pain (63.27%), weight loss (59.18%), fever (36.73%), jaundice (34.69%), and abdominal distention/bloating, without night sweats. Most patients were misdiagnosed with pancreatic tumors, and other misdiagnoses were pseudo-pancreatic cysts, chronic cholecystitis with pancreatitis, and cholecystic tumors. Erythrocyte sedimentation rate was elevated in 85.71% (12/14) of cases; PPD test was strongly positive in 55.56% (5/9); and CA19-9 was mildly elevated in 25% (2/8). CT scans showed a pancreatic mass (31/41) with heterogeneous hypodensity focus (9/41), calcification (6/41), or peripancreatic nodal enlargement (14/41). Ultrasound or CT-guided biopsies were performed in 8.16% (4/49) of cases, including one undergoing EUS-guided fine needle aspiration for cytologic diagnosis. Laparotomy was performed in 45 of 49 cases, and most received combined antituberculosis therapy. Anti-tuberculosis therapy was successful in 42 of 49 cases.

CONCLUSION: Solitary pancreatic tuberculosis is a rare condition with no specific clinical manifestations. The possibility of solitary pancreatic tuberculosis should be considered in patients presenting with a pancreatic mass and irregular pancreas enlargement. Diagnosis should be made cytologically, and laparotomy can be avoided if a definitive diagnosis was established before surgery. Solitary pancreatic tuberculosis can be effectively cured by antituberculosis therapy.

Yield of EUS-guided FNA on the diagnosis of pancreatic/peripancreatic tuberculosis

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.