Tuberculosis of the Pancreas Presenting as Metastatic Pancreatic Carcinoma

Evans, James D.; Hamanaka, Yuichiro; Olliff, Simon; Neoptolemos, John P.

doi:10.1159/000018828

Cited by 26 publications

(24 citation statements)

References 30 publications

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“…Isolated involvement of the pancreas is exceedingly rare worldwide [1,2] . It presents radiologically with variable manifestations, with a wide spectrum of symptoms, and can mimic pancreatic cystic neoplasm [3] .…”

Section: Discussionmentioning

confidence: 99%

Pancreatic tuberculosis masquerading as pancreatic serous cystadenoma

Hong¹,

Kim²,

Joo³

et al. 2009

WJG

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Solitary pancreatic involvement of tuberculosis is rare, especially in an immunocompetent individual, and it may be misdiagnosed as pancreatic cystic neoplasms. Pancreatic cystic neoplasms are being identified in increasing numbers, probably because of the frequent use of radiology and advances in endoscopic techniques. However, they are composed of a variety of neoplasms with a wide range of malignant potential, and it is often difficult to differentiate pancreatic tuberculosis mimicking cystic neoplasms from benign or malignant pancreatic cystic neoplasms. Non-surgical diagnosis of pancreatic tuberculosis is inconclusive and continues to be a challenge in many cases. If so, then laparotomy should be employed to establish the diagnosis. Therefore, pancreatic tuberculosis should be kept in mind during the differential diagnosis of solitary cystic masses in the pancreas. We report a patient who had solitary pancreatic tuberculosis masquerading as pancreatic serous cystadenoma.

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Section: Discussionmentioning

confidence: 99%

Pancreatic tuberculosis masquerading as pancreatic serous cystadenoma

Hong¹,

Kim²,

Joo³

et al. 2009

WJG

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“…Even in the presence of miliary tuberculosis with splenic and hepatic involvement, incidence of pancreatic tuberculosis has been reported to be around 0–4.7% [1, 2]. In a report published in 2000 [3], 38 cases of tuberculosis of the pancreas were reviewed and since then 23 more cases have been reported in the English literature [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]. Most of the published literature on pancreatic tuberculosis is in the form of case reports and our experience is the largest reported series of this disease.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the published literature on pancreatic tuberculosis is in the form of case reports and our experience is the largest reported series of this disease. Pancreatic tuberculosis commonly affects two distinct subsets of patients, those residing in areas where tuberculosis is endemic [3, 16]and those immunocompromised as a result of HIV infection [12]or immunosuppressive drugs [13]. Of these 62 patients with tuberculosis of pancreas, 14 (23%) had HIV seropositivity.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of constitutional symptoms of tuberculosis like fever and anorexia have not been seen in the majority of patients reported. A history of tuberculosis is also reported in only a minority of patients [3]. Patients with pancreatic tuberculosis can present variably, in the form of locally advanced or metastatic pancreatic cancer [3, 16, 19], pancreatic abscess [17, 20], acute pancreatitis [21], chronic pancreatitis [18]or portal hypertension [22].…”

Section: Discussionmentioning

confidence: 99%

“…However, none of these morphological features either alone or in combination are pathognomonic of pancreatic tuberculosis, which makes it difficult to differentiate the disorder from pancreatic cancer. The finding of a normal pancreatogram on endoscopic retrograde pancreatography favors the diagnosis of pancreatic tuberculosis rather than cancer [3], though pancreatic duct changes in the form of stricture have been reported in association with pancreatic tuberculosis in 2 case reports [18, 24]. Similar to our experience, the current literature suggests that the provisional diagnosis in a majority of these patients is pancreatic cancer and the diagnosis of tuberculosis is a surprise finding revealed on histopathological examination of the biopsy specimen obtained at the time of laparotomy [3].…”

Section: Discussionmentioning

confidence: 99%

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Pancreatic Tuberculosis: Still a Histopathological Diagnosis

Chaudhary¹,

Negi²,

Sachdev³

et al. 2002

Dig Surg

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Background: Pancreatic tuberculosis is usually unsuspected as it can present in various forms. Though an uncommon disease, once diagnosed it is potentially curable. Patients and Methods: Retrospective review of the records of 9 patients with histologically proven tuberculosis of the pancreas. Results: In none of the 9 patients was a preoperative diagnosis of tuberculosis possible. The diagnoses considered included: pancreatic cancer (n = 5); acute pseudocyst (n = 1); pancreatic abscess (n = 1); chronic pancreatitis with pancreatic head mass (n = 1), and carcinoma of the colon causing massive lower gastrointestinal bleeding (n = 1). All the patients underwent surgery. The diagnosis of tuberculosis was confirmed by histopathological examination of biopsy specimens obtained at the time of laparotomy. One patient died, the remaining patients received antitubercular therapy and are doing well at a median follow-up period of 26 months. Conclusion: In view of the nonspecific and variable clinical presentation and atypical radiological signs, a clinical diagnosis of pancreatic tuberculosis is usually not possible. Therefore there should be a high index of suspicion for this disease in young patients residing in endemic areas. Our experience highlights the importance of performing biopsy in apparently inoperable pancreatic mass lesions.

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Solitary pancreatic tuberculosis mimicking advanced pancreatic carcinoma

Özden

Emre

Demır

et al. 2001

Journal of Hepato-Biliary-Pancreatic Surgery

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A 40-year-old woman was referred for pancreatic head carcinoma invading the portal vein. The dichotomy between the radiological findings and the general condition of the patient, as well as the laboratory results (no evidence of cholestasis), cast doubt on the diagnosis. There was no history of tuberculosis. The chest radiograph revealed no pathological findings. The anatomic relationships of the lesion entailed a high risk of vascular injury if tissue biopsy were to be done; therefore, diagnostic laparotomy was performed. Biopsy revealed granulomas with caseous necrosis, consistent with tuberculosis. After 6 months of antituberculosis treatment, the lesions had completely resolved. Tuberculosis should be considered in the differential diagnosis of pancreatic masses, particularly in regions where the disease is endemic. The condition usually resembles an advanced pancreatic tumor. Performing a biopsy of inoperable lesions and maintaining a reasonable skepticism in regard to the evaluation of operable lesions (attention to nonexclusive but helpful clues, such as young patient age, history of tuberculosis, absence of jaundice) will lead to the diagnosis in most patients. Diagnostic laparotomy may be required in a small subset of patients. The response to antituberculosis treatment is very favorable. The role of resection (e.g., pancreatoduodenectomy) is very limited.

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Tuberculosis of the Pancreas Presenting as Metastatic Pancreatic Carcinoma

Cited by 26 publications

References 30 publications

Pancreatic tuberculosis masquerading as pancreatic serous cystadenoma

Pancreatic tuberculosis masquerading as pancreatic serous cystadenoma

Pancreatic Tuberculosis: Still a Histopathological Diagnosis

Solitary pancreatic tuberculosis mimicking advanced pancreatic carcinoma

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