Cytologic Diagnosis of Pancreatic Tuberculosis in Immunocompetent and Immunocompromised Patients

Abstract

Pancreatic tuberculosis (PT) is a very rare occurrence in the setting of extrapulmonary tuberculosis. It usually occurs as a complication of miliary tuberculosis in immunodeficient individuals, particularly with HIV infections, but isolated involvement in an immunocompetent patient is extremely rare. Pancreatic involvement by tuberculosis in immunocompromised states, such as AIDS, and isolated involvement in immunocompetent patients require a high index of suspicion. Fine needle aspiration cytology under imaging guidance is highly conclusive.A patient presented with diabetes mellitus and a pancreatic mass clinically diagnosed as pancreatic carcinoma. A second patient, who was HIV seropositive, presented with generalized lymphadenopathy and a pancreatic mass, clinically diagnosed as lymphoma. These were conclusively diagnosed by fine needle aspiration cytology (FNAC) as PT under imaging guidance. After antituberculous therapy the first patient showed a dramatic improvement, whereas the second died; an autopsy was performed. Because of the atypical presentation of PT in immunocompromised and immunocompetent patients, FNAC can be used as a first-line diagnostic intervention. FNAC under imaging guidance is sensitive, specific, rapid and inexpensive. It resolves the diagnostic dilemma and thus avoids major surgery for a clinically diagnosed neoplasm.