Tuberculous Celiac Axis Lymphadenopathy Mimicking Cystic Pancreatic Neoplasm - A Diagnostic Dilemma

Abstract

Cystic pancreatic neoplasms are tumors with malignant potential treated surgically. Isolated tuberculosis of celiac lymph nodes is rare, treatment of this entity being non-surgical. Radiological appearances of cystic pancreatic neoplasm and tuberculous peripancreatic lymph nodal mass is similar and difficult to differentiate. Here we present a case of mass lesion in the region of pancreatic head mimicking cystic pancreatic neoplasm which was actually abdominal tuberculous lymphadenopathy proven by biopsy.

Coeliac lymph node abscess: A case report of a rare manifestation of extrapulmonary tuberculosis

“… 8 Such patients present with nonspecific symptoms such as abdominal pain, nausea, weight loss and fever, similar to our patient, making diagnosis difficult. 9 Furthermore, isolated coeliac lymph node TB can mimic pancreatic neoplasms, lymphoma or metastatic cancer both clinically and radiologically. 9 , 10 TB at other sites or a contact history of TB can aid in arriving at a diagnosis but this is present in less than 30% of patients.…”

“… 9 Furthermore, isolated coeliac lymph node TB can mimic pancreatic neoplasms, lymphoma or metastatic cancer both clinically and radiologically. 9 , 10 TB at other sites or a contact history of TB can aid in arriving at a diagnosis but this is present in less than 30% of patients. 5 In addition, the chest x-ray shows evidence of pulmonary TB in only 10%–68.5%.…”

“… 11 However, imaging may not be able to differentiate tuberculous coeliac lymphadenitis and abscesses from bacterial abscesses or malignancies. 9 …”

Pancreatic tuberculosis

“…4,6,8,18,19,21,23,25,26 Gastrointestinal bleeding has also been reported and may occur because of formation of arterial pseudoaneurysms, portal hypertension, or duodenal mucosal involvement. 3,[28][29][30][31] Other complications include gastric outlet obstruction because of duodenal involvement, occurrence of sinistral portal hypertension, diabetes mellitus, abscess formation, and recurrent acute pancreatitis. [32][33][34][35] Presence of extra-pancreatic lesions especially pulmonary findings on chest roentgenogram may provide a clue to pancreatic involvement by tuberculosis.…”

“…In recent times there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. [1][2][3][4][5][6][7][8] This is possibly because of availability of better imaging modalities as well as the ability to obtain specimens from the pancreas. This review will focus on the available literature regarding the clinical features, diagnosis, evaluation, and treatment of pancreatic tuberculosis.…”