Mediastinal lymphadenopathy in ampullary adenocarcinoma: not always metastatic.
Malignancies can metastasize through hematogenous or lymphatic routes. Enlarged lymph nodes in a known case of malignancy do not always imply metastasis. A middle-aged female patient presented to us with abdominal pain and jaundice. Investigation revealed ampullary growth due to adenocarcinoma. Positron emission tomography-computerized tomography scan revealed uptake of the tracer in the ampullary region as well as in enlarged mediastinal lymph nodes. Endoscopic ultrasound-guided fine needle aspiration cytology of the mediastinal lymphadenopathy revealed it to be tuberculous. Mere radiologic evidence of a distant nodal spread must not be regarded as final evidence and obtaining a tissue diagnosis should be strongly considered, as potentially curative therapy may be offered.
Department of Gastroenterology (Chalapathi A.S. Rao, Surinder S. Rana, Deepak K. Bhasin, Vishal Sharma, Harpal S. Dhaliwal, Kartar Singh).
Chalapathi A S
CA
Rao
Department of Gastroenterology (Chalapathi A.S. Rao, Surinder S. Rana, Deepak K. Bhasin, Vishal Sharma, Harpal S. Dhaliwal, Kartar Singh).
Surinder S
SS
Rana
Department of Gastroenterology (Chalapathi A.S. Rao, Surinder S. Rana, Deepak K. Bhasin, Vishal Sharma, Harpal S. Dhaliwal, Kartar Singh).
Deepak K
DK
Bhasin
Histopathology Department (Ritambhra Nada).
Ritambhra
R
Nada
Nuclear Medicine (Santosh Sampath, Bhagwant R. Mittal), Postgraduate Institute of Medical Education and Research (PGIMER), India.
Santosh
S
Sampath
Nuclear Medicine (Santosh Sampath, Bhagwant R. Mittal), Postgraduate Institute of Medical Education and Research (PGIMER), India.
Bhagwant R
BR
Mittal
Department of Gastroenterology (Chalapathi A.S. Rao, Surinder S. Rana, Deepak K. Bhasin, Vishal Sharma, Harpal S. Dhaliwal, Kartar Singh).
Vishal
V
Sharma
Department of Gastroenterology (Chalapathi A.S. Rao, Surinder S. Rana, Deepak K. Bhasin, Vishal Sharma, Harpal S. Dhaliwal, Kartar Singh).
Harpal S
HS
Dhaliwal
Department of Gastroenterology (Chalapathi A.S. Rao, Surinder S. Rana, Deepak K. Bhasin, Vishal Sharma, Harpal S. Dhaliwal, Kartar Singh).
Kartar
K
Singh
adenocarcinoma; endoscopic ultrasound; lymph node; pancreas; tuberculosis