Summary
A 24-year-old man presented with vague abdominal fullness and a mild epigastric dull pain for about 3 months was found to have a pancreatic head tumor at a medical center 2 months ago. He came to our hospital for further treatment. Ultrasonography, endoscopic retrograde cholangiopancreatography (ERCP) and abdominal computed tomography (CT) all revealede a pancreatic head tumor. Laparotomy was performed because pancreatic head carcinoma was highly suspected. Indurated mass in the pancreatic head, enlarged lymph nodes and white tubercles on the intestine proved to be tuberculosis on histological examination of a frozen section. Acid fast bacilli were also found. The patient was given antituberculous therapy and is now doing well. To avoid unnecessary laparotomy, CT, echo-guided percutaneous aspiration cytology or biopsy and culture of the tissue for mycobacteria should be done in a patient with pancreatic mass, especially in a region where pulmonary and abdominal tuberculosis are common.
Zusammenfassung
Ein 24jähriger Mann klagte seit drei Monaten über unklares abdominelles Völlegefühl und einen dumpfen, leicht epigastrischen Schmerz. Zwei Monate vor Aufnahme war in einem klinischen Zentrum ein Pankreaskopftumor festgestellt worden. Sonographisch, durch endoskopische retrograde Cholangiopankreatographie und Computertomographie des Abdomens wurde der Pankreaskopftumor bestätigt. Wegen des hochgradigen Verdachtes auf Pankreaskopfkarzinom wurde eine Laparotomie vorgenommen. Dabei fand sich im Pankreaskopf eine indurierte Masse, vergrößerte Lymphknoten und weiße Tuberkel auf dem Darm. Die histologische Untersuchung bestätigte das Vorliegen tuberkulöser Granulome. Säurefeste Stäbchen konnten histologisch ebenfalls nachgewiesen werden. Der Patient wurde mit Tuberkulostatika behandelt und ist jetzt in guter Verfassung. Um unnötige Laparotomien zu vermeiden, sollte bei Patienten mit Pankreastumor eine computertomographisch oder sonographisch kontrollierte Aspirationsbiopsie mit zytologischer oder histologischer Untersuchung durchgeführt und auch kulturell der Nachweis von Mykobakterien versucht werden. Dies gilt vor allem für Regionen, in denen die Lungentuberkulose und abdominelle Tuberkulosen keine Seltenheit darstellen.
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Wu, C.S., Wang, S.H. & Kuo, T.T. Pancreatic tuberculosis mimicking pancreatic head carcinoma: A case report and review of the literature. Infection 22, 287–289 (1994). https://doi.org/10.1007/BF01739920
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DOI: https://doi.org/10.1007/BF01739920