Pancreatic Tuberculosis Diagnosed by EUS: One Disease, Many Faces
Context Pancreatic/para-pancreatic tuberculosis is an extremely rare clinical entity even in endemic regions. It can present as a cystic or solid pancreatic mass mimicking pancreatic malignancy. There are no specific imaging criteria and the clinical symptoms remain vague. Therefore, most cases are diagnosed after surgical exploration for presumed pancreatic neoplasia. Case report We report five cases of pancreatic tuberculosis each time with a different clinical presentation, in an occidental country setting where the diagnosis was done by EUS guided FNA (EUS-FNA). Conclusion EUS-FNA is a safe and promising technique for the diagnosis of pancreatic/para-pancreatic tuberculosis, avoiding unnecessary surgery.
Image: Space-occupying lesion with cellular proliferation.
Khan R, Abid S, Jafri W et al. Diagnostic dilemma of abdominal tuberculosis in non-HIV patients: an ongoing challenge for physicians. World J Gastroenterol 2006; 12: 6371-6375.
Auerbach O. Acute generalized miliary tuberculosis. Am J Pathol 1944; 20:121-136.
Paraf A, Menager J, Texier J. Tuberculosis of the pancreas and tuberculosis of the lymph nodes of the upper region of the abdomen. Rev Med Chir Mal Foie 1966; 41: 101-126.
Crowson MC, Perry M, Burden E. Tuberculosis of the pancreas: a rare cause of obstructive jaundice.Br J Surg 1984; 71: 239.
Stapmbler JB, Klibaner MI, Bliss CM et al. Tuberculous abscess of the pancreas. Endoscopy 1981; 13: 178-80.
Adler D, Jacobson BC, Davila RE et al. ASGE guidelines: complications of EUS .Gastrointest Endosc. 2005; 61: 8-12.
Fonds des Affections Respiratoires - FARES asbl. Bruxelles, Belgique. http://www.fares.be/content/view/175/239/
Bhansali S. Abdominal tuberculosis; Experience with 300 cases. Am J Gastroenterol 1977; 67: 324- 337.
Suvadip C, Matthias LS, Anderson K et al. Tuberculosis of the pancreas: A diagnostic Challenge solved by Endoscopic Ultrasound, a case series. J Gastrointes Liver Dis 2012;21 ,105-107.
Chaudhary A, Negi SS, Sachdev AK et al. Pancreatic tuberculosis: still a histopathological diagnosis. Dig Surg 2002, 19; 389-392.
Schneider A, von Birgelen C, Duhrsen U et al. Two cases of pancreatic tuberculosis in nonimmunocompromised patients; a diagnostic challenge and a rare case of portal hypertension. Pancreatology 2002, 2; 69-73.
Weiss ES, Klein WM, Yeo CJ. Peripancreatic tuberculosis mimicking pancreatic neoplasia. J Gastrointest Surg 2005, 9; 254-262.
Cheng R, Grieco VS, Shuhart MC, Rulyak SJ. EUS-guided FNA diagnosis of pancreatic tuberculosis.Gastrointest Endosc 2006; 64: 660-663.
Song TJ, Lee SS, Park DH et al. Yield of EUS-guided FNA on the diagnosis of pancreatic /peripancreatic tuberculosis. Gastrointest Endosc 2009; 69: 484-491.
Woodfield JC, Windsor JA, Godfrey CC et al. Diagnosis and management of isolated pancreatic tuberculosis: recent experience and literature review. J Surg 2004; 74: 368-371.
Copyright (c) 2014 Haydeh Vafa, Marianna Arvanitakis, Celso Matos, Pieter Demetter, Pierre Eisendrath, Emmanuel Toussaint, Axel Benoit Hittelet, Jacques Deviere, Myriam Delhaye
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