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Peripancreatic tuberculosis mimicking pancreatic neoplasia

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Tuberculosis of the pancreas and peripancreatic lymph nodes is an extremely rare disorder that has been reported with increased frequency in the past several years. Despite the fact that abdominal tuberculosis can generally be managed by pharmacotherapy alone, invasive procedures are often used before the establishment of the correct diagnosis, sometimes leading to unnecessary interventions and delayed treatment. To set the stage for our review, we first describe a case of a 31-year-old woman from India who initially presented with nonspecific symptoms and a pancreatic cystic lesion but was later diagnosed with peripancreatic tuberculosis. We then present a review of the current literature on peripancreatic and pancreatic tuberculosis, with a focus on diagnosis and management of the disease, but we also touch on issues such as epidemiology, infection control, and tissue acquisition. Finally, we offer clues that can be used to help identify patients who present with otherwise vague symptoms who may harbor pancreatic or peripancreatic tuberculosis. It is our hope that this case report and review of the literature will raise awareness and improve the management of this uncommon but serious disorder.

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References

  1. Dye D, Scheele S, Dolin P, Pathania V, Raviglione M. Global burden of tuberculosis: Estimated incidence, prevalence, and mortality by country. JAMA 1999;282:677–686.

    Article  PubMed  CAS  Google Scholar 

  2. Aston NO, Chir M. Abdominal tuberculosis. World J Surg 1997;21:492–499.

    Article  PubMed  CAS  Google Scholar 

  3. Raviglione MC, Snider DE, Kochi A. Global epidemiology of tuberculosis: Morbidity and mortality of a worldwide epidemic. JAMA 1995;273:220–226.

    Article  PubMed  CAS  Google Scholar 

  4. Mehta JB, Dutt A, Harvill L, Mathews KM. Epidemiology of extrapulmonary tuberculosis: A comparative analysis with pre-AIDS era. Chest 1991;99:1134–1138.

    PubMed  CAS  Google Scholar 

  5. Chen C, Yang C, Yeh Y, Yang J,ChouD. Pancreatic tuberculosis with obstructive jaundice-A case report. Am J Gastroenterol 1999;94:2534–2536.

    PubMed  CAS  Google Scholar 

  6. Hulnick DH, Megibow AJ, Naidich DP, et al. Abdominal tuberculosis: CT evaluation. Radiology 1985;157:199–204.

    PubMed  CAS  Google Scholar 

  7. Sinan T, Sheikh M, Ramadan S, Sahwney S, Behbehani A. CT features in abdominal tuberculosis: 20 years experience. BMC Med Imaging 2002;2:3–10.

    Article  PubMed  Google Scholar 

  8. Mourad FH, McLean A, Farthing MJG. Tuberculous pancreatitis: A diagnostic problem. J Clin Gastroenterol 1995;20:237–240.

    Article  PubMed  CAS  Google Scholar 

  9. Crowson MC, Perry M, Burden E. Tuberculosis of the pancreas: A rare cause of obstructive jaundice. Br J Surg 1984;71:239.

    Article  PubMed  CAS  Google Scholar 

  10. Fan ST, Yan KW, Lau WY, Wong KK. Tuberculosis of the pancreas: A rare cause of massive gastrointestinal bleeding. Br J Surg 1986;73:373.

    Article  PubMed  CAS  Google Scholar 

  11. D’Cruz S, Sachdev A, Kaur L, et al. Fine needle aspiration diagnosis of isolated pancreatic tuberculosis. A case report and review of the literature. J Pancreas 2003;4:158–162.

    Google Scholar 

  12. Demir K, Kaymakoglu S, Bessisik F, et al. Solitary pancreatic tuberculosis in immunocompetent patients mimicking pancreatic carcinoma. J Gastroenterol Hepatol 2001;16:1071–1074.

    Article  PubMed  CAS  Google Scholar 

  13. Fischer G, Spengler U, Neubrand M, Saurerbruch T. Isolated tuberculosis of the pancreas masquerading as a pancreatic mass. Am J Gastroenterol 1995;90:2227–2230.

    PubMed  CAS  Google Scholar 

  14. Kwon AH, Inui H, Kamiyama Y. Preoperative laparoscopic examination using surgical manipulation and ultrasonography for pancreatic lesions. Endoscopy 2002;34:464–468.

    Article  PubMed  CAS  Google Scholar 

  15. Liu Q, Zhenping H, Bie P. Solitary pancreatic tuberculous abscess mimicking pancreatic cystadenocarcinoma: A case report. BMC Gastroenterol 2003;3:1–6.

    Article  PubMed  Google Scholar 

  16. Sanabe N, Ikematsu Y, Nishiwaki Y, et al. Pancreatic tuberculosis. J Hepatobil Pancreat Surg 2002;9:515–518.

    Article  Google Scholar 

  17. Schneider A, von Birgelen C, Duhrsen U, Gerken G, Runzi M. Two cases of pancreatic tuberculosis in nonimmunocompromised patients. A diagnostic challenge and rare cause of portal hypertension. Pancreatology 2002;2:69–73.

    Article  PubMed  Google Scholar 

  18. Stock KP, Riemann JF, Stadler W, Rosch W. Tuberculosis of the pancreas. Endoscopy 1981;13:178–180.

    PubMed  CAS  Google Scholar 

  19. Riaz AA, Singh A, Robshaw P, Isla AM. Tuberculosis of the pancreas diagnosed with needle aspiration. Scand J Infect Dis 2001;34:303–304.

    Article  Google Scholar 

  20. Auerbach O. Acute generalized miliary tuberculosis. Am J Pathol 1944;20:121–136.

    Google Scholar 

  21. Bhansali SK. Abdominal tuberculosis: Experiences with 300 cases. Am J Gastroenterol 1977;67:324–337.

    PubMed  CAS  Google Scholar 

  22. Franco-Paredes C, Leonard M, Jurado R, Blumberg HM, Smith R. Tuberculosis of the pancreas: Report of two cases and review of the literature. Am J Med Sci 2002;323:54–58.

    Article  PubMed  Google Scholar 

  23. Chaudhry A, Negi SS, Sachdev AK, Gondal R. Pancreatic tuberculosis: Still a histopathological diagnosis. Dig Surg 2002; 19:339–392.

    Google Scholar 

  24. Uygur-Bayramicli O, Dabak G, Dabak R. A clinical dilemma: Abdominal tuberculosis. World J Gastroenterol 2003;9:1098–1101.

    PubMed  Google Scholar 

  25. Al Muneff M, Memish Z, Al Mahmoud S, et al. Tuberculosis in the belly: A review of forty-six cases involving the gastrointestinal tract. Scand J Gastroenterol 2001;36:528–532.

    Article  Google Scholar 

  26. Akhan O, Pringot J. Imaging of abdominal tuberculosis. Eur Radiol 2002;12:312–323.

    Article  PubMed  Google Scholar 

  27. Mallery JS, Centeno BA, Hahn PF, et al. Pancreatic tissue sampling guided by EUS, CT/US, and surgery: A comparison of sensitivity and specificity. Gastrointest Endosc 2002;56:218–224.

    Article  PubMed  Google Scholar 

  28. Chow KM, Chow VC, Szeto CC. Indication for peritoneal biopsy in tuberculous peritonitis. Am J Surg 2003;185:567–573.

    Article  PubMed  Google Scholar 

  29. Borgdorff MW, Nagelkerke N, van Soolingen D, et al. Analysis of tuberculosis transmission between nationalities in the Netherlands in the period 1993–1995 using DNA fingerprinting. Am J Epidemiol 1998;147:187–194.

    PubMed  CAS  Google Scholar 

  30. Thakur V, Mukherjee U, Kumar K. Elevated serum cancer antigen 125 levels in advanced abdominal tuberculosis. Med Oncol 2001;18:289–291.

    Article  PubMed  CAS  Google Scholar 

  31. Kouraklis G, Glinavou A, Karayiannakis A, Karatzas G. Primary tuberculosis of the pancreas mimicking a pancreatic tumor. Int J Pancreatol 2002;29:151–153.

    Article  Google Scholar 

  32. Panzuto F, D’Amato A, Laghi A, et al. Abdominal tuberculosis with pancreatic involvement: A case report. Dig LiverDis 2003; 35:283–287.

    Article  CAS  Google Scholar 

  33. Ozden I, Emre A, Demir K, et al. Solitary pancreatic tuberculosis mimicking advanced pancreatic carcinoma. J Hepatobil Surg 2001;8:279–283.

    Article  CAS  Google Scholar 

  34. Brugge WR, Mueller PR, Misdraja J. Case records of the Massachusetts General Hospital, case 8-2004: A 28-year-old man with abdominal pain, fever, and a mass in the region of the pancreas. N Engl J Med 2004;350:1131–1138.

    Article  PubMed  CAS  Google Scholar 

  35. Xia F, Poon RT, Wang S, et al. Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: Experience from China. World J Gastroenterol 2003;9:1361–1364.

    PubMed  Google Scholar 

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Correspondence to Charles J. Yeo M.D..

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Weiss, E.S., Klein, W.M. & Yeo, C.J. Peripancreatic tuberculosis mimicking pancreatic neoplasia. J Gastrointest Surg 9, 254–262 (2005). https://doi.org/10.1016/j.gassur.2004.06.010

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  • DOI: https://doi.org/10.1016/j.gassur.2004.06.010

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