Diagnosis Of Pancreatic Tuberculosis Research Articles

Pancreatic Tuberculosis: Current Update on Clinical Manifestation and Diagnostic Modalities

Pancreatic tuberculosis is a very rare disease in either immunocompetent or immunocompromised hosts.The incidence of pancreatic tuberculosis was reported to be less than 4.7% in an autopsy series on tuberculosis patients in 1944 and 2% in another autopsy series in 1966.Despite that, in recent times, an increase in the number of reports of pancreatic TB has been noted.This condition is possibly caused by an improvement in diagnostic imaging tools, the development of different techniques that make obtaining specimens from the pancreas possible, and an increase in HIV prevalence worldwide. Therefore, this review article discusses the current update in the clinical manifestations and diagnostic modalities of pancreatic tuberculosis.Pancreatic tuberculosis is a very rare condition with a various range of non-specific clinical presentation and image features overlapping with those seen in pancreatic neoplasia. A combination of diagnostic modalities should be done to establish a diagnosis of pancreatic tuberculosis. Currently, direct histopathological examination is the best way of diagnosing tuberculosis. US/CT/EUS-guided biopsy is the recommended diagnostic technique. Most patients with pancreatic tuberculosis respond well to anti-tuberculosis drugs.

Progress in diagnosis and treatment of pancreatic tuberculosis

Pancreatic tuberculosis is a chronic and specific disease of the pancreas, which is rare in clinic.Pancreatic tuberculosis accounts for less than 5% of general miliary tuberculosis.This disease is often secondary to tuberculosis in other parts of the body.Because of the lack of awareness of pancreatic tuberculosis, it is easy to be misdiagnosed as pancreatic cancer.In the past, there were reports of pancreatic tuberculosis misdiagnosed as pancreatic cancer and then underwent pancreaticoduodenectomy treatment.In clinical practice, most of the cases of pancreatic tuberculosis were confirmed by during operation or postoperative pathology.In recent years, with the increase of the incidence of tuberculosis, the reports of pancreatic tuberculosis have also increased.Therefore, the study reviewed the literature of pancreatic tuberculosis in recent years in order to improve the understanding of pancreatic tuberculosis by the medical workers. Key words: Tuberculosis; Pancreas; Pancreatic neoplasms; Review; Therapeutics; Diagnosis; Pathology; Databases, bibliographic

Ultrasound imaging features of isolated pancreatic tuberculosis.

Background and Objectives:Isolated pancreatic tuberculosis (PTB) is extremely rare worldwide. The purpose of this multicenter retrospective study is to analyze imaging features of histologically confirmed isolated PTB in order to determine the diagnostic features of the new methods contrast enhanced ultrasound (CEUS), ultrasound elastography and contrast enhanced endoscopic ultrasound (CE-EUS).Patients and Methods:We report on a retrospective data collection of 12 cases of PTB confirmed by histology or cytology. All examinations were interpreted by two independent readers in consensus. CEUS, CE-EUS and ultrasound elastography were performed according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines.Results:In PTB patients the common bile duct was never dilated. Multiple retroperitoneal lymph nodes are the second important B-mode ultrasound feature detected in 75% of PTB patients. CE-EUS was performed in three PTB patients demonstrating hyperenhancement. On elastography, all PTB lesions were markedly stiffer than surrounding pancreatic parenchyma.Conclusions:Here we report the first time on CEUS and elastography features of PTB. PTB had some typical imaging features with iso- or hyperenhancement on CE(E) US. PTB is markedly stiffer on elastography. If clinicians are aware of clinical features of PTB and conduct appropriate investigations with multiple modalities including B-mode ultrasound, CEUS, and EUS guided fine needle aspiration, diagnosis of PTB without laparotomy is possible and the disease can be effectively treated with anti-tuberculous drugs.

Diagnosis and treatment of pancreatic tuberculosis

Pancreatic tuberculosis (PTB) is a rare, chronic, specific and infectious disease which is generally secondary to tuberculosis at the common sites of pancreas, and it has a high misdiagnosis rate due to the hidden onset and non-specific symptoms of PTB. A patient with PTB was admitted to the First Affiliated Hospital of Zhengzhou University in June 2014. Before operation, the space-occupying lesions of the head of pancreas were detected by preoperative imaging examination, and the patient was regarded as with pancreatic cancer. Intraoperative exploration showed cystic duct involvement, and the granulomatous inflammation was detected by rapid pathological examination using frozen section technique, after that the patient received granuloma resection + cholecystectomy according to suspected PTB. The diagnosis of PTB was confirmed by post-operative pathological examination, and the patient received liver-protective and anti-tuberculosis treatments after discharge. Key words: Tuberculosis, pancreas; Diagnosis; Therapy

Endoscopic ultrasound guided fine needle aspiration for diagnosis of pancreatic tuberculosis: Report of one case

Endoscopic ultrasound guided fine needle aspiration for diagnosis of pancreatic tuberculosis: Report of one case

Gastrointestinal: Pancreatic tuberculosis masquerading as malignancy

A 73 year old man presented with a 2 months history of abdominal pain, occasional night sweats, and 4 Kg weight loss. Laboratory evaluation showed a mild normocytic anemia and erythrocyte sedimentation rate (ESR) of 78 mm. Serum levels of CA 19-9, amylase, and liver enzymes were within normal limits. An abdominal CT scan revealed a heterogeneous mass lesion in the pancreatic head (Figure 1; black arrow), and lymphadenopathies in the portahepatis and para-aortic regions. Endoscopic ultrasound (EUS) demonstrated a 20 mm solidcystic mass lesion in the pancreatic head (Figure 2). EUS-guided fine needle aspiration (FNA) from the pancreatic mass was performed. Cytology showed aggregation of epithelioid histiocytes with regular oval nuclei with smooth nuclear borders and fine chromatin pattern on HE 600X magnification). The smears stained by Ziehl Neelsen method showed beaded, rod shaped acid fast bacilli (Figure 3b; black arrow; 1500X magnification). Polymerase chain reaction of the FNA sample became positive for Mycobacterium tuberculosis. The patient received a 6-month course of anti-tubeculosis therapy. His symptoms completely resolved on treatment and ESR returned back to normal at the end of treatment. The patient is doing well one year after completion of therapy. Pancreatic tuberculosis (TB) is a very rare disorder. It is speculated that the antibacterial effects of the pancreatic enzymes may prevent the development of this disorder. Pancreatic TB presents as a mass lesion in the pancreas and mimics pancreatic malignancy. As it is evident in Figure 2, the mass lesion was solid-cystic on EUS. The main differential diagnoses of pancreatic solid-cystic masses include cystic neuroendocrine tumor, mucinous cystadenocarcinoma, serous cystadenoma, solid pseudopapillary neoplasm and cystic degeneration of pancreatic adenocarcinoma. Pancreatic TB should also be considered in the differential diagnosis of pancreatic solid-cystic mass lesions. The diagnosis of pancreatic TB has traditionally been made on biopsy samples taken during surgery. However, EUS-guided FNA is increasingly being used to make the diagnosis. Pancreatic TB should be suspected in patients with pancreatic solid-cystic mass lesions who have conditions such as living in or emigrating from endemic areas, presence of predominant constitutional symptoms, normal serum CA 19-9 level, and associated lymphadenopathies in the portahepatis and paraaortic regions.

Isolated tuberculosis of the pancreas mimicking a pancreatic tumor with concomitant choledocholithiasis

Introduction: Isolated pancreatic tuberculosis is an extremely rare condition, especially in immunocompetent individuals. Its presenting features are vague and non-specific. In addition, its radiological features often mimic pancreatic malignancy. The diagnosis is often made after surgery with its resultant morbidity. Isolated pancreatic tuberculosis, therefore, poses a great diagnostic and management challenge. Case Report: We describe the first case report of primary pancreatic tuberculosis mimicking a cystic tumor of the pancreas with concomitant choledocholithiasis in an immunocompetent young woman. She had no known exposure history or demonstrable extrapancreatic involvement. Diagnosis of pancreatic tuberculosis was established by endoscopic ultrasound (EUS)-guided fine-needle aspiration cytology (FNAC) and she responded to antituberculous chemotherapy. Endoscopic stenting

Endoscopic ultrasound-guided fine needle aspirate: a useful method in the diagnosis of pancreatic tuberculosis

Endoscopic ultrasound-guided fine needle aspirate: a useful method in the diagnosis of pancreatic tuberculosis

Pancreatic Tuberculosis: Role of Multidetector Computed Tomography

Pancreatic tuberculosis (TB) is an extremely rare clinical entity even in countries with high endemism [1]. Men and women are affected equally, with a mean age of approximately 40 years [2]. It usually occurs as a complication of miliary TB and immunodeficiency, with isolated involvement of the pancreas being extremely rare. It is frequently misdiagnosed as pancreatic neoplasm. Lately, the increased incidence of this entity is related to the frequency of abdominal TB in immunocompromised patients and the improvement in imaging methods of the pancreas. Because the clinical and radiographic presentation mimics pancreatic cancer, its diagnosis is a clinical challenge, and most cases are diagnosed after surgical exploration. The tuberculin skin test is useful in the diagnosis of pancreatic TB, but it has a false-negative rate of 10%e25% [3]. The definitive diagnosis rests on histologic and bacteriologic evidence of TB. Pancreatic TB should be kept in mind among the differential diagnosis of pancreatic solitary masses, especially in young people in developing countries [4]. Detecting Mycobacterium tuberculosis DNA by a polymerase chain reaction in the tissue obtained from the lesion allows sameday results, with up to 77% sensitivities, although sample contamination and poor assay design can result in false negatives. Advancement in gene amplification techniques can now identify genes associated with antibiotic resistance but cannot give information regarding drug sensitivities, and,

Diagnosis of pancreatic tuberculosis by combined, contrast-enhanced sonography and endoscopic ultrasound-guided fine-needle aspiration.

A 79-year-old woman complaining of epigastric pain was examined by her local physician, who found an abdominal mass and referred the patient to our department. Abdominal plain computed tomography revealed a mass, 50mm in size, with slight calcification on the ventral side of the head of the pancreas. On abdominal ultrasound, the mass lesion consisted of an aggregation of hypoechoic masses, with a heterogeneous hyperechoic region at its center. On contrast ultrasonography, only the hyperechoic region was stained. (18)F-Fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed FDG accumulation in the same region. It was difficult to differentiate between a malignant pancreatic tumor and an inflammatory disease on imaging, but since QuantiFERON TB2G testing was positive, pancreatic tuberculosis was suspected, and endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) was performed to obtain a definitive diagnosis. Samples from the hypoechoic region consisted of necrotic tissue, while those from the hyperechoic region consisted of pancreatic tissue together with granulation tissue. BCG immunostaining was positive, and a diagnosis of pancreatic tuberculosis was made. If EUS-FNA is performed on stained areas seen on contrast ultrasonography, this will probably enable a more accurate diagnosis of pancreatic tuberculosis with low invasiveness.