Pancreatic tuberculosis with splenic tuberculosis mimicking advanced pancreatic cancer with splenic metastasizes: a case report

An Unusual Cause of Pancreatic Tumor

Pancreatic tuberculosis (TB) is a rare condition that can be challenging to distinguish from other pancreatic neoplasms. We present the case of a 48-year-old Indian male who complained of persistent vague epigastric pain for two months. Other physicians saw him and treated him like a dyspeptic case. He gave a history of daily alcohol consumption. Routine investigations, including amylase and lipase levels, were within normal limits. However, an abdominal ultrasound revealed a cystic lesion in the body of the pancreas, prompting further investigation. A subsequent abdominal CT scan revealed a tumor of 6x4 cm in diameter with solid and cystic components in the pancreatic body. Although tumor markers were not remarkable, inflammatory markers showed elevated levels of ESR (erythrocyte sedimentation rate) of 95 mm/hr and CRP (C-reactive protein) of 83 mg/L, with normal hemoglobin. Endosonography (EUS) with fine needle aspiration (FNA) was performed to achieve a definitive diagnosis. EUS was performed with a linear echoendoscope, which revealed the mass, which had solid and cystic components. Fluid was aspirated from the cystic part and FNA passes were performed in the solid part. Microscopic examination and aspirated fluid culture confirmed the presence of Mycobacterium tuberculosis, while the solid part revealed caseation-indicated granulomas, indicative of TB. The patient was promptly initiated on a seven-month course of three anti-TB medications, leading to normalization of ESR and CRP levels during the treatment period. A follow-up abdominal CT scan showed complete resolution of the pancreatic lesion, indicating successful management. This case is rare and all the data in the literature is mainly in the form of case reports. Using EUS with FNA has transformed the diagnosis of pancreatic malignancy into a curable disease that could be easily managed with anti-TB medications.

Isolated pancreatic tuberculosis masquerading pancreatic malignancy

Pancreatic tuberculosis is the rarest form of abdominal and extrapulmonary tuberculosis. We present a patient in his 40s who presented with pain abdomen and a fever. On examination, the patient had mild jaundice and right hypochondriac tenderness. Blood investigation was suggestive of obstructive jaundice. Imaging studies were representative of pancreatic head lesion, causing mild intrahepatic biliary radical dilatation. Endoscopic ultrasound-guided fine-needle aspiration done from the pancreatic head lesion was diagnostic of tuberculosis. The patient was started on antitubercular medications and responded well.

Isolated pancreatic tuberculosis with splenic tuberculosis mimicking lymphoma malignum: A case report

Tuberculosis is an endemic disease in certain parts of the world. This disease typically presents in the lungs, but it may also appear within the abdomen, such as in the pancreas. There can be challenges in diagnosing isolated pancreatic tuberculosis as it may mimic other diseases radiologically. We present a 33-year-old female with intermittent abdominal pain and weight loss. Chest x-rays showed normal findings while noncontrast abdominal computed tomography (CT) showed a solid cystic mass in the pancreas and in the spleen. Contrast-enhanced CT showed an inhomogeneous cystic mass in the body and tail of the pancreas with peripheral rim enhancement. A laparotomy procedure was performed, and tuberculosis was confirmed histopathologically. In this case report, we highlight the challenging nature of diagnosing isolated pancreatic and splenic tuberculosis due to its presentation, which is similar to other neoplastic processes.

OUP accepted manuscript

We present a case of pancreatic and splenic tuberculosis (TB) in a 15-year-old human immunodeficiency virus-negative patient who was initially misdiagnosed as suffering from a pancreatic carcinoma with splenic metastases. Pancreatic and splenic TB are extremely rare in young immunocompetent patients, with a nonspecific clinical presentation, making the diagnosis elusive.

Isolated Pancreatic Tuberculosis Mimicking Pancreatic Cancer: A Diagnostic Challenge

Isolated pancreatic tuberculosis is an exceedingly rare condition, even in areas of the world where the disease is highly prevalent. Abdominal tuberculosis is a common form of extrapulmonary tuberculosis but involvement of the pancreas is very rare. We report a case of isolated pancreatic tuberculosis presenting as a pancreatic mass in a patient with persistent abdominal pain and jaundice. Clinically and radiologically, the mass mimicked a malignant pancreatic tumor with a vastly different prognostic implication and therapeutic approach. Endoscopic ultrasound with fine-needle aspiration (EUS-FNA) can provide valuable diagnostic information in this scenario. After the tissue showed evidence of acid-fast bacilli and the cultures showed growth of Mycobacterium tuberculosis, antituberculosis therapy was initiated. Conservative management is usually successful in alleviating symptoms and leading to a cure. The excellent response to ATT makes it imperative that these patients are diagnosed early and managed appropriately to avoid unnecessary surgery and associated morbidity.

Pancreatic tuberculosis

Pancreatic tuberculosis is very rare, but recently, there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. It closely mimics pancreatic cancer, and before the advent of better imaging modalities it was often detected as a histological surprise in patients resected for a presumed pancreatic malignancy. The usual presentation involves abdominal pain, loss of appetite and weight, jaundice which can be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. Computed tomography (CT) of the abdomen is an important tool for evaluation of patients with pancreatic tuberculosis. This CT imaging yields valuable information about the size and nature of tubercular lesions along with the presence of ascites and lymphadenopathy. However, there are no distinctive features on CT that distinguish it from pancreatic carcinoma. Endoscopic ultrasound provides high resolution images of the pancreatic lesions as well as an opportunity to sample these lesions for cytological confirmation. The presence of granulomas is the most common finding on histological/cytological examination with the presence of acid fast bacilli being observed only in minority of patients. As there are no randomized or comparative studies on treatment of pancreatic tuberculosis it is usually treated like other forms of tuberculosis. Excellent cure rates are reported with standard anti tubercular therapy given for 6-12 months.

Pancreatic Tuberculosis

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.

Hepatic tuberculosis mimicking metastasis in a case of carcinoma sigmoid colon

Tuberculosis (TB) presenting as isolated liver mass without clinical evidence of TB is difficult to diagnose preoperatively and is usually mimicked by primary or metastatic carcinoma of the liver. Hepatic TB associated with carcinoma colon is a rare association which has very rarely been reported in the literature. This case illustrates the diagnostic difficulties of hepatic TB and the need to consider it in the differential diagnosis of hepatic nodular lesions in carcinoma colon patients. Here, we report a case of 48-year-old female who presented in the casualty with features of acute intestinal obstruction. Preoperatively a mass was seen at the hepatic flexure along with three lesions in the liver presumed to be metastatic in origin. However, histopathology of the mass revealed adenocarcinoma colon and the liver lesion proved to be hepatic TB. We wish to highlight that on encountering a hepatic lesion in a carcinoma colon patient the possibility of hepatic TB should also be kept in mind apart from the obvious possibility of metastasis especially in an endemic country like India.

Isolated pancreatic tuberculosis mimicking as carcinoma: a case report and review of the literature

INTRODUCTION

Pancreatic tuberculosis is a rare disease even in endemic countries for tuberculosis. Here, we report a case of pancreatic tuberculosis from tuberculosis endemic zone presenting as obstructive jaundice mimicking pancreatic cancer.

CASE PRESENTATION

A 41-year-old male presented with features of malignant obstructive jaundice. Ultrasonography and computed tomography scan showed mass in the pancreatic head and uncinate process. He underwent a pancreatoduodencetomy. Histological examination showed typical features of tuberculosis. Antitubercular drugs were started and he remains well six months after surgery.

CONCLUSION

Tuberculosis should be considered as a differential diagnosis to an obscure pancreatic mass in younger or middle aged patient residing in tuberculosis endemic zone.