title: Fine needle aspiration diagnosis of isolated pancreatic tuberculosis. A case report and review of literature.
abstract: BACKGROUND
  Tuberculosis is a common disease in the developing world and its incidence is slowly increasing in developed countries where a resurgence has been seen subsequent to the AIDS epidemic. Tuberculosis, in its extrapulmonary form, though emerging as a clinical problem, rarely affects the pancreas. The pancreas is biologically protected from being infected by Mycobacterium tuberculosis. Pancreatic tuberculosis presents with a wide spectrum of symptoms such as abdominal pain, constitutional symptoms, obstructive jaundice, iron deficiency anemia, pancreatic abscess, massive gastro-intestinal bleeding, acute/chronic pancreatitis, secondary diabetes, splenic vein thrombosis and a pancreatic mass mimicking malignancy. It should be suspected clinically in patients having a pancreatic mass, particularly if the patient is young, not jaundiced, coming from an area of high tuberculosis endemicity and having a normal endoscopic retrograde cholangio-pancreatography. Its indolent course and vague symptomatology along with non-specific laboratory and radiological findings call for greater vigilance.
  
  
  METHODS
  We report a case of pancreatic tuberculosis which presented with pancreatic pain. Imaging techniques revealed a mass located in the head of the pancreatic gland. Fine needle aspiration cytology revealed caseating granulomas. The diagnosis of pancreatic tuberculosis was made and the patient was put on anti-tubercular therapy. Five months later, a repeat CT scan of the abdomen revealed resolution of the pancreatic lesion.
  
  
  CONCLUSIONS
  The diagnosis of pancreatic tuberculosis is usually not suspected prior to laparotomy. Most patients have been diagnosed at laparotomy, thus fine needle aspiration cytology/biopsy is useful in obviating the need for major surgery with its accompanying morbidity. Exploratory laparotomy may be required in technically difficult cases due to risk of injury to the vessels in the vicinity of the mass.
authors.affiliation: Department of Medicine, Government Medical College and Hospital, Chandigarh, India. sanjaydcruz@satyam.net.in
authors.forename: Sanjay
authors.initials: S
authors.lastname: D'Cruz
authors.forename: Atul
authors.initials: A
authors.lastname: Sachdev
authors.forename: Ladbans
authors.initials: L
authors.lastname: Kaur
authors.forename: Uma
authors.initials: U
authors.lastname: Handa
authors.forename: Ashish
authors.initials: A
authors.lastname: Bhalla
authors.forename: Sarabmeet S
authors.initials: SS
authors.lastname: Lehl
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D006801:Humans; D008297:Male; D010179:Pancreas / Q000473:pathology*; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014376:Tuberculosis / Q000000981:diagnostic imaging / Q000473:pathology*