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A 22-year-old female, with no particular past medical history except for consumption of raw milk, was hospitalized with symptoms of severe epigastric pain, penetrating to the back and associated vomiting; symptoms were progressive over a one-month period. She had no other change in her general health. Examination revealed no signs of clinical tuberculosis (sweats, weight loss, hemoptysis). Laboratory findings and tumor markers were normal.Abdominal CT revealed a heterogeneous tumoral mass in the pancreatic isthmus and body, measuring 6 × 4.5 cm (Fig. 1); the mass appeared partially necrotic and there was extensive celiac mesenteric lymphadenopathy, infiltration of the peri-pancreatic fat, and moderate ascites. The peritoneum and omentum had a scalloped irregular border, particularly in the peri-colic gutters, and a nodule in the right iliac fossa was suggestive of peritoneal carcinomatosis.Diagnostic laparoscopy showed hypertrophy of the pancreas, mainly in the area of the isthmus and body, associated with numerous nodules studding the pancreatic capsule and peritoneum; this had the appearance of disseminated peritoneal carcinomatosis (Fig. 2). Biopsies of these nodules showed epithelioid granulomas with giant cells, diagnostic of pancreatic and peritoneal tuberculosis. The remainder of the diagnostic testing, including chest X-ray, and acid-fast staining of sputum and urine was negative. The patient was treated with quadruple antituberculous antibiotic therapy with isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months, followed by another 6 months of two-drug therapy with isoniazid and rifampin. Follow-up abdominal CT at 3 months after initial therapy confirmed the disappearance of the pancreatic lesion; the pancreas was of normal size with homogeneous enhancement and conserved lobularity (Fig. 3). DiscussionOur case is a good illustration of the difficulties inherent in characterizing a deep mass by imaging. The images of this lesion were strongly evocative of a tumoral mass, despite the young age of our patient. Pancreatic tuberculosis is a rare entity and is usually associated * Corresponding author. Tel.: +216 98 63 93 53.

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