SlideShare ist ein Scribd-Unternehmen logo
1 von 6
Downloaden Sie, um offline zu lesen
Disclosure Statement of Financial Interest
Dr Maghrebi Houcine
“Nothing To Disclose”
EP04B-015
Tuberculosis of the Pancreas: Diagnostic Challenges
H. Maghrebi, A. Heni, R. Rhaim, A. Makni, A. Daghfous, F. Fteriche,
M. Jouini, M. Kacem, Z. Bensafta
Department of general surgery , Rabta Hospital, Tunisia
Introduction :
Isolated tuberculosis of pancreas and peripancreatic lymphnodes is very rare. It presents with a
wide spectrum of symptoms. It is often mistaken for malignancy and can pose a diagnostic
challenge. In fact, most cases of pancreatic tuberculosis have been diagnosed after surgery
carried out for a suspected malignancy.
Aim: We report a case of an atypical peripancreatic tuberculosis, mimicking a carcinoma on
imaging technique and which was only diagnosed after a percutaneous biopsy of the mass.
Case report
Thirty one- year-old men presented with 2 months history of epigastric abdominal pain and weight
loss . His past medical history was unremarkable for chronic diseases or hospitalization.
Ultrasound and computed tomogram (figures 1+2) scan revealed a complex solid/cystic mass of the
of pancreas of 6 cm. Several large para-aortic necrotic lymph nodes, with node in the small bowel
mesentery were noted. Hepatic transaminases, alkaline phosphatase, Serum ACE, CA 19.9 were
within normal range. All other laboratory findings were normal.
Figure 1+2
Magnetic Resonance Cholangio Pancreatogram (MRCP) scan (Fig. 3) showed the same informations.
A percutaneous biopsy from the pancreatic mass and lymph nodes was performed. Cytology revealed
multiple granulomas with areas of caseating necrosis and clusters of multinucleated giant cells. Anti-
tuberculous therapy (ATT) was initiated (isoniazid, rifampin, ethambutol, and pyrazinamide for two months
and completed therapy with ten additional months of isoniazid and rifampin). The symptoms resolved and
follow-up imaging showed a complete resolution of the mass, lymphadenopathy and symptoms.
Figure 3: Magnetic Resonance Cholangio Pancreatogram
Discussion:
• Tuberculosis (TB) is a major health problem worldwide. Even in endemic areas, pancreatic TB is uncommon.
• The clinical features of pancreatic TB is uncommon and indistinguishable from a pancreatic neoplasm. It include
weight loss, anorexia, abdominal pain, fever, night sweats…. Patients may present with a pancreatic mass lesion
such our patient .
• The most common location of PPT as a mass has been reported in the head or body as in our cases.
• US and CT scan may show a diffusely enlarged pancreatic mass lesion. These findings are non-specific and may be
seen with focal pancreatitis of any etiology, similar to pancreatic carcinoma. The common bile duct and the
pancreatic duct have been reported to be normal. The presence of hypodense lymph nodes with rim enhancement in
the peripancreatic region, ascites and/or mural thickening in the ileo-cecal region may suggest the possibility of TB.
• Due to the lack of pathognomic radiological features for pancreatic TB, most cases have been diagnosed in the past
at laparotomy performed for a suspicion of pancreatic malignancy. Few cases have been diagnosed by fine needle
aspiration cytology/biopsy.
• The role of ultrasound/endoscopic ultrasound-guided fine-needle aspiration cytology/biopsy has proven to be an
excellent tool for the cytological diagnosis of pancreatic and peripancreatic masses.
• Most cases of pancreatic tuberculosis respond well to anti-tubercular treatment with isoniazid /Rifampin/
Pyrazinamide/ Ethambutol or Streptomycin for 6-12 months as in our cases.
Références
1. Rezeig MA, Fashir BM, Al-Suhaibani H, Al-Fadda M, Amin T, Eisa H. Pancreatic tuberculosis mimicking pancreatic carcinoma: four case reports and
review of literature. Dig Dis Sci 1998;43:329 – 331.
2. Kouraklis G, Glinavou A, Karayiannakis A, Karatzas G. Primary tuberculosis of the pancreas mimicking a pancreatic tumour. Int J Pancreatol
2001;29:151 – 153.
3. Schneider A, von Birgelen C, Duhrsen U, Gerken G, Runzi M. Two cases of pancreatic tuberculosis in nonimmunocompromised patients. A
diagnostic challenge and a rare cause of portal hypertension. Pancreatology 2002;2: 69-73.
4. Weiss ES, Klein WM, Yeo CJ. Peripancreatic tuberculosis mimicking pancreatic neoplasia. J Gastrointest Surg 2005;9: 254 – 262
5. De Backer AI, Mortele KJ, Bomans P, De Keulenaer BL, Vanschoubroeck IJ, Kockx MM. Tuberculosis of the pancreas: MRI features. AJR Am J
Roentgenol 2005;184: 50- 54.
6. D’Cruz S, Sachdev A, Kaur L, Handa U, Bhalla A, Lehl SS. Fine needle aspiration diagnosis of isolated pancreatic tuberculosis. A case report and
review of literature. JOP 2003; 4: 158 – 162.
7. Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis
and staging of pancreatic carcinoma. Gastrointest Endosc 1997; 45: 387 – 393.
Conclusion :
Pancreatic tuberculosis is very rare and it closely resembles a pancreatic malignancy. Despite its rarity, it
should be considered for differential diagnosis of pancreatic mass in endemic developing countries.
Improvement in imaging techniques and the resulting image-guided interventions have helped us in the
preoperative diagnosis of pancreatic masses.

Weitere ähnliche Inhalte

Ähnlich wie Tuberculosis of the Pancreas Diagnostic Challenges.ppt

Calcifying Fibrous Tumor Mimicking Pancreatic Cancer
Calcifying Fibrous Tumor Mimicking Pancreatic CancerCalcifying Fibrous Tumor Mimicking Pancreatic Cancer
Calcifying Fibrous Tumor Mimicking Pancreatic Cancersemualkaira
 
Calcifying Fibrous Tumor Mimicking Pancreatic Cancer
Calcifying Fibrous Tumor Mimicking Pancreatic CancerCalcifying Fibrous Tumor Mimicking Pancreatic Cancer
Calcifying Fibrous Tumor Mimicking Pancreatic Cancersemualkaira
 
Renal Tumor with Pancreatic Metastasis: About a Case Report _Crimson Publishers
Renal Tumor with Pancreatic Metastasis: About a Case Report _Crimson PublishersRenal Tumor with Pancreatic Metastasis: About a Case Report _Crimson Publishers
Renal Tumor with Pancreatic Metastasis: About a Case Report _Crimson PublishersCrimsonpublisherssmoaj
 
Mucinous adenocarcinoma-of-the-colon-mimicking-an-abdominal-wall-cellulitis
Mucinous adenocarcinoma-of-the-colon-mimicking-an-abdominal-wall-cellulitisMucinous adenocarcinoma-of-the-colon-mimicking-an-abdominal-wall-cellulitis
Mucinous adenocarcinoma-of-the-colon-mimicking-an-abdominal-wall-cellulitisAnnex Publishers
 
Sister mary joseph nodule the fungating umbilical mass
Sister mary joseph nodule the fungating umbilical massSister mary joseph nodule the fungating umbilical mass
Sister mary joseph nodule the fungating umbilical massJack Michel MD
 
Abdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case ReportAbdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case ReportJohnJulie1
 
Abdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case ReportAbdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsuppubs1pubs1
 
Abdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case ReportAbdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsemualkaira
 
Abdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case ReportAbdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case Reportsuppubs1pubs1
 
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...JohnJulie1
 
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...suppubs1pubs1
 
special investigations in abdominal pathologies
special investigations in abdominal pathologiesspecial investigations in abdominal pathologies
special investigations in abdominal pathologiesHari Krishnan
 
Common Bile Duct Cyst: About an Observation and Review of the Literature
Common Bile Duct Cyst: About an Observation and Review of the LiteratureCommon Bile Duct Cyst: About an Observation and Review of the Literature
Common Bile Duct Cyst: About an Observation and Review of the Literatureasclepiuspdfs
 
Malignant Neoplasms of Stomach.pptx
Malignant Neoplasms of Stomach.pptxMalignant Neoplasms of Stomach.pptx
Malignant Neoplasms of Stomach.pptxPushpa Lal Bhadel
 
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...iosrjce
 
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case ReportSolid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case ReportJohnJulie1
 

Ähnlich wie Tuberculosis of the Pancreas Diagnostic Challenges.ppt (20)

Calcifying Fibrous Tumor Mimicking Pancreatic Cancer
Calcifying Fibrous Tumor Mimicking Pancreatic CancerCalcifying Fibrous Tumor Mimicking Pancreatic Cancer
Calcifying Fibrous Tumor Mimicking Pancreatic Cancer
 
Calcifying Fibrous Tumor Mimicking Pancreatic Cancer
Calcifying Fibrous Tumor Mimicking Pancreatic CancerCalcifying Fibrous Tumor Mimicking Pancreatic Cancer
Calcifying Fibrous Tumor Mimicking Pancreatic Cancer
 
Renal Tumor with Pancreatic Metastasis: About a Case Report _Crimson Publishers
Renal Tumor with Pancreatic Metastasis: About a Case Report _Crimson PublishersRenal Tumor with Pancreatic Metastasis: About a Case Report _Crimson Publishers
Renal Tumor with Pancreatic Metastasis: About a Case Report _Crimson Publishers
 
International Journal of Hepatology & Gastroenterology
International Journal of Hepatology & GastroenterologyInternational Journal of Hepatology & Gastroenterology
International Journal of Hepatology & Gastroenterology
 
Mucinous adenocarcinoma-of-the-colon-mimicking-an-abdominal-wall-cellulitis
Mucinous adenocarcinoma-of-the-colon-mimicking-an-abdominal-wall-cellulitisMucinous adenocarcinoma-of-the-colon-mimicking-an-abdominal-wall-cellulitis
Mucinous adenocarcinoma-of-the-colon-mimicking-an-abdominal-wall-cellulitis
 
Sister mary joseph nodule the fungating umbilical mass
Sister mary joseph nodule the fungating umbilical massSister mary joseph nodule the fungating umbilical mass
Sister mary joseph nodule the fungating umbilical mass
 
Stomach 2
Stomach 2Stomach 2
Stomach 2
 
Abdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case ReportAbdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case Report
 
Abdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case ReportAbdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case Report
 
Abdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case ReportAbdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case Report
 
Abdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case ReportAbdominal Splenosiscausing Hydronephrosis- A Case Report
Abdominal Splenosiscausing Hydronephrosis- A Case Report
 
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
 
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
A Case Report of Primary Ovarian Squamous Cell Carcinoma: Pathways (And Pitfa...
 
special investigations in abdominal pathologies
special investigations in abdominal pathologiesspecial investigations in abdominal pathologies
special investigations in abdominal pathologies
 
Austin Journal of Clinical Case Reports
Austin Journal of Clinical Case ReportsAustin Journal of Clinical Case Reports
Austin Journal of Clinical Case Reports
 
Common Bile Duct Cyst: About an Observation and Review of the Literature
Common Bile Duct Cyst: About an Observation and Review of the LiteratureCommon Bile Duct Cyst: About an Observation and Review of the Literature
Common Bile Duct Cyst: About an Observation and Review of the Literature
 
Malignant Neoplasms of Stomach.pptx
Malignant Neoplasms of Stomach.pptxMalignant Neoplasms of Stomach.pptx
Malignant Neoplasms of Stomach.pptx
 
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...
Abdominal Tuberculosis Revisited–A single institutional experience of 72 case...
 
3069576
30695763069576
3069576
 
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case ReportSolid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
Solid Pseudopapillary Tumor of the Pancreas (Frantz Tumor) : A Case Report
 

Kürzlich hochgeladen

CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 

Kürzlich hochgeladen (20)

CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 

Tuberculosis of the Pancreas Diagnostic Challenges.ppt

  • 1. Disclosure Statement of Financial Interest Dr Maghrebi Houcine “Nothing To Disclose”
  • 2. EP04B-015 Tuberculosis of the Pancreas: Diagnostic Challenges H. Maghrebi, A. Heni, R. Rhaim, A. Makni, A. Daghfous, F. Fteriche, M. Jouini, M. Kacem, Z. Bensafta Department of general surgery , Rabta Hospital, Tunisia Introduction : Isolated tuberculosis of pancreas and peripancreatic lymphnodes is very rare. It presents with a wide spectrum of symptoms. It is often mistaken for malignancy and can pose a diagnostic challenge. In fact, most cases of pancreatic tuberculosis have been diagnosed after surgery carried out for a suspected malignancy. Aim: We report a case of an atypical peripancreatic tuberculosis, mimicking a carcinoma on imaging technique and which was only diagnosed after a percutaneous biopsy of the mass.
  • 3. Case report Thirty one- year-old men presented with 2 months history of epigastric abdominal pain and weight loss . His past medical history was unremarkable for chronic diseases or hospitalization. Ultrasound and computed tomogram (figures 1+2) scan revealed a complex solid/cystic mass of the of pancreas of 6 cm. Several large para-aortic necrotic lymph nodes, with node in the small bowel mesentery were noted. Hepatic transaminases, alkaline phosphatase, Serum ACE, CA 19.9 were within normal range. All other laboratory findings were normal. Figure 1+2
  • 4. Magnetic Resonance Cholangio Pancreatogram (MRCP) scan (Fig. 3) showed the same informations. A percutaneous biopsy from the pancreatic mass and lymph nodes was performed. Cytology revealed multiple granulomas with areas of caseating necrosis and clusters of multinucleated giant cells. Anti- tuberculous therapy (ATT) was initiated (isoniazid, rifampin, ethambutol, and pyrazinamide for two months and completed therapy with ten additional months of isoniazid and rifampin). The symptoms resolved and follow-up imaging showed a complete resolution of the mass, lymphadenopathy and symptoms. Figure 3: Magnetic Resonance Cholangio Pancreatogram
  • 5. Discussion: • Tuberculosis (TB) is a major health problem worldwide. Even in endemic areas, pancreatic TB is uncommon. • The clinical features of pancreatic TB is uncommon and indistinguishable from a pancreatic neoplasm. It include weight loss, anorexia, abdominal pain, fever, night sweats…. Patients may present with a pancreatic mass lesion such our patient . • The most common location of PPT as a mass has been reported in the head or body as in our cases. • US and CT scan may show a diffusely enlarged pancreatic mass lesion. These findings are non-specific and may be seen with focal pancreatitis of any etiology, similar to pancreatic carcinoma. The common bile duct and the pancreatic duct have been reported to be normal. The presence of hypodense lymph nodes with rim enhancement in the peripancreatic region, ascites and/or mural thickening in the ileo-cecal region may suggest the possibility of TB. • Due to the lack of pathognomic radiological features for pancreatic TB, most cases have been diagnosed in the past at laparotomy performed for a suspicion of pancreatic malignancy. Few cases have been diagnosed by fine needle aspiration cytology/biopsy. • The role of ultrasound/endoscopic ultrasound-guided fine-needle aspiration cytology/biopsy has proven to be an excellent tool for the cytological diagnosis of pancreatic and peripancreatic masses. • Most cases of pancreatic tuberculosis respond well to anti-tubercular treatment with isoniazid /Rifampin/ Pyrazinamide/ Ethambutol or Streptomycin for 6-12 months as in our cases.
  • 6. Références 1. Rezeig MA, Fashir BM, Al-Suhaibani H, Al-Fadda M, Amin T, Eisa H. Pancreatic tuberculosis mimicking pancreatic carcinoma: four case reports and review of literature. Dig Dis Sci 1998;43:329 – 331. 2. Kouraklis G, Glinavou A, Karayiannakis A, Karatzas G. Primary tuberculosis of the pancreas mimicking a pancreatic tumour. Int J Pancreatol 2001;29:151 – 153. 3. Schneider A, von Birgelen C, Duhrsen U, Gerken G, Runzi M. Two cases of pancreatic tuberculosis in nonimmunocompromised patients. A diagnostic challenge and a rare cause of portal hypertension. Pancreatology 2002;2: 69-73. 4. Weiss ES, Klein WM, Yeo CJ. Peripancreatic tuberculosis mimicking pancreatic neoplasia. J Gastrointest Surg 2005;9: 254 – 262 5. De Backer AI, Mortele KJ, Bomans P, De Keulenaer BL, Vanschoubroeck IJ, Kockx MM. Tuberculosis of the pancreas: MRI features. AJR Am J Roentgenol 2005;184: 50- 54. 6. D’Cruz S, Sachdev A, Kaur L, Handa U, Bhalla A, Lehl SS. Fine needle aspiration diagnosis of isolated pancreatic tuberculosis. A case report and review of literature. JOP 2003; 4: 158 – 162. 7. Chang KJ, Nguyen P, Erickson RA, Durbin TE, Katz KD. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc 1997; 45: 387 – 393. Conclusion : Pancreatic tuberculosis is very rare and it closely resembles a pancreatic malignancy. Despite its rarity, it should be considered for differential diagnosis of pancreatic mass in endemic developing countries. Improvement in imaging techniques and the resulting image-guided interventions have helped us in the preoperative diagnosis of pancreatic masses.