Primary tuberculosis of the pancreas mimicking a pancreatic tumor.
BACKGROUND
Diagnosis of tuberculosis of the pancreas is often missed, and may present to the clinician as a difficult diagnostic problem.


METHODS
We report an extremely rare case of a 35-year-old woman who admitted for acute pain in the right upper quadrant, jaundice, fever 38 degrees C and chills. During the last 8 mo, she developed increasing fatigue and a weight loss of approx 10 kg.


RESULTS
Computed tomography (CT) of the abdomen showed a mass in the head of the pancreas, and upper gastrointestinal endoscopy revealed a stenosis of the second part of duodenum and a pancreatico-duodenum fistula. Frozen sections by direct trucut needle biopsy raised suspicions of a malignancy, and a Whipple procedure was performed as a radical procedure. The final histopathology revealed a chronic granulomatous lesion with caseating necrosis. Mycobacterium of tuberculosis was detected using the polymerase chain reaction-based assay.


CONCLUSIONS
This unusual case emphasizes that in suspected cases of pancreatic carcinoma with an atypical presentation, an attempt should be made to confirm the diagnosis by CT-guided needle biopsy, or by ultrasound endoscopic fine-needle aspiration.
Kouraklis
G
G
Second Department of Propedeutic Surgery, Athens University School of Medicine, Greece. gkouraklis@hotmail.com
Glinavou
A
A
Karayiannakis
A
A
Karatzas
G
G
D000328:Adult; D001707:Biopsy, Needle; D003937:Diagnosis, Differential; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D010182:Pancreatic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D016133:Polymerase Chain Reaction; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000175:diagnosis* / Q000000981:diagnostic imaging