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Pancreatic tuberculosis mimicking a neoplastic mass in an immunosuppressed patient who also presented adenopathy syndrome: Case report. IDCases 2022; 30:e01642. [DOI: 10.1016/j.idcr.2022.e01642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/05/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
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Bhowmik A, Herth FJ. Bronchoscopy and other invasive procedures for tuberculosis diagnosis. Tuberculosis (Edinb) 2018. [DOI: 10.1183/2312508x.10020518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Dong Y, Jürgensen C, Puri R, D’Onofrio M, Hocke M, Wang WP, Atkinson N, Sharma M, Dietrich CF. Ultrasound imaging features of isolated pancreatic tuberculosis. Endosc Ultrasound 2018; 7:119-127. [PMID: 28721972 PMCID: PMC5914183 DOI: 10.4103/2303-9027.210901] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/30/2016] [Indexed: 12/13/2022] Open
Abstract
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.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - Christian Jürgensen
- Department of Hepatology and Gastroenterology, Charité University, 10117 Berlin, Germany
| | - Rajesh Puri
- Institute of Digestive and Hepatobiliary Sciences, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Mirko D’Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Wen-Ping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - Nathan Atkinson
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, India
| | - Christoph F. Dietrich
- Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, Germany
- Medical Department, Caritas-Krankenhaus, Germany
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Krylov NN, Pyatenko EA, Alekberzade AV, Kupriyanov IE. [Pancreatic tuberculosis]. Khirurgiia (Mosk) 2018:122-125. [PMID: 30560858 DOI: 10.17116/hirurgia2018121122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prevalence, risk factors of primary pancreatic tuberculosis, clinical symptoms and data of instrumental and laboratory diagnosis are reviewed in the article. The authors emphasized the peculiarities of differential diagnosis with pancreatic malignancies and advisability of the most informative methods - endoscopy and fine-needle aspiration procedure.
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Affiliation(s)
- N N Krylov
- Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia
| | - E A Pyatenko
- Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia
| | - A V Alekberzade
- Sechenov First Moscow State Medical University, Moscow, Russia, Moscow, Russia
| | - I E Kupriyanov
- Department of human anatomy of Sechenov First Moscow State Medical University, Moscow, Russia
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Abstract
Pancreatic tuberculosis is very rare, but recently, there has been a spurt in the number of reports on pancreatic involvement by tuberculosis. It closely mimics pancreatic cancer, and before the advent of better imaging modalities it was often detected as a histological surprise in patients resected for a presumed pancreatic malignancy. The usual presentation involves abdominal pain, loss of appetite and weight, jaundice which can be associated with cholestasis, fever and night sweats, palpable abdominal lump, and peripheral lymphadenopathy. Computed tomography (CT) of the abdomen is an important tool for evaluation of patients with pancreatic tuberculosis. This CT imaging yields valuable information about the size and nature of tubercular lesions along with the presence of ascites and lymphadenopathy. However, there are no distinctive features on CT that distinguish it from pancreatic carcinoma. Endoscopic ultrasound provides high resolution images of the pancreatic lesions as well as an opportunity to sample these lesions for cytological confirmation. The presence of granulomas is the most common finding on histological/cytological examination with the presence of acid fast bacilli being observed only in minority of patients. As there are no randomized or comparative studies on treatment of pancreatic tuberculosis it is usually treated like other forms of tuberculosis. Excellent cure rates are reported with standard anti tubercular therapy given for 6-12 months.
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Affiliation(s)
- Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Kumar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Santhosh S, Bhattacharya A, Rana SS, Bhasin DK, Srinivasan R, Mittal BR. Pancreatic tuberculosis: Evaluation of therapeutic response using F-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography. Indian J Nucl Med 2014; 29:257-9. [PMID: 25400368 PMCID: PMC4228592 DOI: 10.4103/0972-3919.142635] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
F-18 fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET/CT) is a functional imaging technique that monitors glucose metabolism in tissues. Pulmonary tuberculosis (TB) has been reported to show intense uptake of FDG, with a decrease in metabolism of the tuberculous lesions after successful anti-tubercular treatment (ATT). The authors present a patient with pancreatic TB and demonstrate the usefulness of FDG PET/CT in monitoring the response to ATT.
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Affiliation(s)
- Sampath Santhosh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Díaz Fontenla F, Miranda-Bautista J, Hernando Alonso A, Urizar Gorosarri M, Jiménez Pérez JM, Senosiáin Labiano M. [Pancreatic tuberculosis: presentation in the form of pancreatitis with portal hypertension]. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:417-20. [PMID: 24378142 DOI: 10.1016/j.gastrohep.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 11/04/2013] [Indexed: 12/28/2022]
Affiliation(s)
- Fernando Díaz Fontenla
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - José Miranda-Bautista
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Ana Hernando Alonso
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | | | - María Senosiáin Labiano
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
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Ozkan F, Bulbuloglu E, Inci MF, Sayar H, Kahraman H, Yuksel M. Isolated pancreatic tuberculosis mimicking malignancy and causing obstructive jaundice. J Gastrointest Cancer 2013; 44:118-20. [PMID: 22528321 DOI: 10.1007/s12029-012-9374-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kongkam P, Ang TL, Vu CKF, Dy FT, Yasuda K, Rerknimitr R, Varadarajulu S, Dhir V, Chong VH, Zhen DJ, Wong JYY, Ho KY. Current status on the diagnosis and evaluation of pancreatic tumor in Asia with particular emphasis on the role of endoscopic ultrasound. J Gastroenterol Hepatol 2013; 28:924-30. [PMID: 23488477 DOI: 10.1111/jgh.12198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 12/16/2022]
Abstract
In Asia, the incidence of pancreatic cancer in some countries has been increasing. Owing to most cases being diagnosed late, prognosis for pancreatic cancer remains dismal. It is clear that the future for pancreatic cancer lies in early detection. While the possible presence of pancreatic masses is often first raised by non-invasive abdominal imaging, such as computerized tomography and magnetic resonance imaging, smaller lesions and locoregional lymph node metastases are often not detectable by these means. Endoscopic ultrasonography (EUS) offers a higher sensitivity (93-100%) for detection of small potentially curable pancreatic masses than other existing imaging modalities. It is also recommended for the evaluation of portal vein confluence, portal vein, celiac axis, and superior mesentric artery origin, and exclusion of resectability. Due to the closer proximity of EUS to the target structure, and lower rate of needle tract seeding, EUS-guided fine-needle aspiration of pancreatic mass is considered the most suitable tissue acquisition technique. Lastly, EUS also enables the performance of endoscopic interventions. Its performance can be further enhanced with newer techniques, including contrast-enhanced ultrasound and elastrography. It is anticipated that in the near future, molecular technologies may make it possible to detect microscopic amounts of cancer in tissue or blood, predict relapse and survival after therapy, as well as determine optimal therapy.
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Affiliation(s)
- Pradermchai Kongkam
- Endoscopic Ultrasound Research Unit, Chulalongkorn University, Bangkok, Thailand
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