Fine needle aspiration diagnosis of isolated pancreatic tuberculosis: A case report

Abstract

Tuberculosis (TB) involving the pancreas are uncommon, especially when present in immunocompetent hosts. Pancreatic TB is more frequently associated with miliary TB or widely disseminated disease. Pancreatic TB may present as cystic or solid pancreatic masses, pancreatic abscess or acute or chronic pancreatitis. Majority of the cases are diagnosed after surgical exploration for presumed pancreatic malignancy and pre-operative diagnosis is quite difficult. However, improvement in imaging techniques and the resulting image-guided interventions gradually can obviate the need for more invasive diagnostic surgical procedures and expedite the planning of therapy. Herein, we report a rare case of isolated pancreatic TB which presented with pancreatic mass lesion in an immunocompetent host. Diagnosis was made by contrast enhanced computed tomography and guided fine needle aspiration of the pancreatic mass which revealed acid-fast bacilli on Ziehl-Neelsen stain. The case was treated successfully with antituberculous drugs. Pancreatic tuberculosis should be considered in the differential diagnosis of a pancreatic mass when the patient is young, residing in the endemic zone of tuberculosis. Every attempt should be made to diagnose the cases to prevent unnecessary operation.

Keywords: Antituberculous drugs; Computed tomography; Fine needle aspiration; Pancreatic mass; Pancreatic tuberculosis; Pre-operative diagnosis.

Figure 1

Contrast-enhanced computerized tomography of abdomen showing bulky pancreas (A), retro pancreatic lymphadenopathy (B) and hypodense lesion in the body and tail of the pancreas (3.5 cm × 2.4 cm) with peripheral enhancement.

Figure 2

CT guided fine-needle aspiration cytology from the pancreatic lesion shows collection of epitheloid cells (inset) forming granuloma along with pancreatic ductal and acinar cells with patchy necrotic material (Giemsa staining) (A), Ziehl-Neelsen stain showing acid fast bacilli in the background of proteinaceous material (B).

Figure 3

Review Contrast-enhanced computerized tomography of the abdomen performed at 9 mo of ATT showing near complete regression of pancreas size and resolution of hypodense lesion at body and tail.