PANCREATIC TUBERCULOSIS AND ITS DIAGNOSIS BY ENDOSCOPIC ULTRASONOGRAPHY: REPORT OF TWO CASES AND REVIEW OF THE LITERATURE

Pancreatic tuberculosis in an 18-year-old patient

An 18-year-old male patient presented with abdominal pain, nausea, and diarrhea. Subsequent laboratory investigations involving the patient's blood samples revealed an inflammatory syndrome. Subsequent radiographic investigations (CT scan, MRI, and endoscopic ultrasound with biopsies) led to the discovery of a heterogenic cystic lesion in the tail of the pancreas. Although the investigations orientated the diagnosis towards a pseudopapillary tumor, no certain pathological diagnosis could be obtained. After a multidisciplinary meeting, surgery was chosen as the designated therapeutic option. The patient underwent left pancreatectomy and no complications were encountered. The pathological examination revealed isolated pancreatic tuberculosis. Currently, the patient is under treatment and no longer presents any digestive symptoms.

Peripancreatic Tuberculous Lymphadenitis with Biliary Obstruction Diagnosed by Endoscopic Ultrasound-guided Fine-needle Aspiration Biopsy

A 57-year-old man with a history of tuberculosis (TB) was found to have a pancreatic head mass, accompanied by stenosis of the common bile duct. Due to the inherent difficulty in differentiating pancreatic carcinoma from an inflammatory mass, endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) was thus performed. The pathological findings confirmed granuloma with caseous necrosis, and the results of the QuantiFERON TB2G test were positive. Accordingly, the patient was diagnosed with peripancreatic TB and thereafter was successfully treated with anti-TB therapy. Based on the findings of this case, we conclude that EUS-FNAB is a useful modality for the diagnosis of pancreatic TB.