title: Tuberculous lymphadenopathy mimicking pancreatic neoplasm.
abstract: Abdominal tuberculosis (TB) is the sixth most common location of extrapulmonary TB involvement. Because its symptoms and signs are often nonspecific, laboratory and imaging findings mimic other diseases including carcinoma. Therefore, the diagnosis of abdominal TB is challenging. We herein report a case of 74-year-old woman who presented with abdominal pain, anorexia, and weight loss. She had been given a diagnosis of pancreatic head carcinoma. Laboratory data was unremarkable except for elevated erythrocyte sedimentation rate, CA125, and sIL-2R. CT scan revealed multiple enlarged peripancreatic lymph nodes and concentric thickening of the ileocecal wall. Colonoscopy demonstrated deformed ileocecal valve and erosions. Histological examination showed epithelioid granulomas. Laparoscopy revealed numerous white tubercles diffusely covering the parietal peritoneum. Histopathological images of peripancreatic lymph node revealed large multiple caseating granulomas surrounded by Langhans_giant cells and epithelioid cells. Polymerase chain reaction and culture of the specimens were positive for Mycobacterium tuberculosis. Tuberculous lymphadenopathy, colitis, and peritonitis were finally diagnosed. She responded well to the antitubercular treatment.
authors.affiliation: Department of Infectious, Respiratory, and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan.
authors.forename: Kunikazu
authors.initials: K
authors.lastname: Hoshino
authors.forename: Shingo
authors.initials: S
authors.lastname: Arakaki
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shibata
authors.forename: Tatsuji
authors.initials: T
authors.lastname: Maeshiro
authors.forename: Akira
authors.initials: A
authors.lastname: Hokama
authors.forename: Fukunori
authors.initials: F
authors.lastname: Kinjo
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shiraishi
authors.forename: Tadashi
authors.initials: T
authors.lastname: Nishimaki
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujita