Primary pancreatic tuberculosis mimicking pancreatic body cancer. A case report and review of the literature

Abstract

Isolated pancreatic tuberculosis (PT) is an extremely rare disease, with non-specific clinical characteristics, making the diagnosis often challenging with pancreatic cancers. Here we report a case of a 36-year-old female, who was admitted to our hospital after suffering from a 3-month history of epigastric abdominal pain, night sweats and weight loss. The physical examination was normal. The radiological findings revealed the presence of a pancreatic mass and multiple abdominal lymphadenopathy, suggestive of malignancy. The initial differential diagnosis suspected was pancreatic tuberculosis. Tuberculosis skin test was performed and was highly positive (>22 mm). Computed tomography (CT)-guided biopsy of peripancreatic lymph node was carried out and the histopathological exam confirmed the diagnosis of PT. Therefore, anti-tuberculous therapy was initiated, leading to clinical and radiological improvement. The diagnosis of PT is rare and can sometimes be misleading. It should be considered when a pancreatic mass is observed, especially in endemic countries, to ovoid unnecessary interventions.

Keywords: Anti-Tuberculosis therapy; Histopathology; Pancreatic cancer; Pancreatic mass; Pancreatic tuberculosis.

Fig. 1

Abdominal ultrasound showing a 40-mm mass in the pancreatic body (A) with multiple peripancreatic lymphadenopathy (B).

Fig. 2

Abdominal Computed tomography (CT) revealed a 45 × 28 mm low-density lesion, arising from the pancreatic body.

Fig. 3

Histological findings, hematoxylin and eosin, showing caseous granulomatous inflammation (A, x100). It corresponds in peripheral rim of epithelioid histiocytes with some multinucleated giant cells surrounding a central granular necrotic region (B, x200).