Advertisement

Pancreatic tuberculosis in an immunocompetent young female mimicking a malignant tumor: A case report and diagnostic radiological investigation

      Highlights

      • Pancreatic tuberculosis (PTB) can mimick a malignant tumor.
      • PTB is hard to differentiate from other pancreatic diseases by standard MRI.
      • MRI apparent diffusion coefficient values provide valuable insights for diagnostic.

      Abstract

      Tuberculosis remains the leading cause of infectious disease related death worldwide with extrapulmonary tuberculosis being particularly difficult to diagnose. Here, we report a case of pancreatic tuberculosis (PTB) in an immunocompetent young female, which mimicked a malignant tumor diagnosed by endoscopic ultrasound-guided fine needle aspiration and biopsy (EUS-FNAB). A 19-year-old Japanese female with no prior medical history presented with abdominal epigastralgia and appetite loss lasting 2 months. A solid lobular mass was observed in the pancreatic head with enhanced abdominal computed tomography and magnetic resonance imaging suggested it was a malignant pancreatic tumor. Using EUS-FNAB, granulomas with caseous necrosis and acid-fast bacilli were observed. Polymerase chain reaction results were positive for Mycobacterium tuberculosis but negative for Mycobacterium avium complex. Therefore, the patient was diagnosed with PTB. Her symptoms and radiological findings improved with a standard antituberculosis therapy. PTB is difficult to differentiate from other pancreatic diseases with Magnetic resonance imaging (MRI) patterns of T1, T2 weighted, or diffusion-weighted image (DWI) images. To investigate novel radiological diagnostics for PTB, we focused on MRI apparent diffusion coefficient (ADC) values, which have not been investigated in this context. The present case showed 0.52 × 10−3 mm2/s; additionally, the mean value of other mass-forming pancreatic diseases, such as pancreatic cancer was 1.592 × 10−3 mm2/s (the range: 1.015–3.025 × 10−3 mm2/s). The range does not overlap with the present PTB case or other pancreatic diseases. Therefore, ADC values may be useful as a noninvasive radiological diagnostic method for PTB.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Furin J.
        • Cox H.
        • Pai M.
        Tuberculosis.
        Lancet. 2019; 393: 1642-1656
        • Peto H.M.
        • Pratt R.H.
        • Harrington T.A.
        • LoBue P.A.
        • Armstrong L.R.
        Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006.
        Clin Infect Dis. 2009; 49: 1350-1357
        • Bhurwal A.
        • Haq M.M.
        • Sapru S.
        • Tortora M.
        • Ramasamy D.
        Isolated pancreatic tuberculosis mimicking pancreatic cancer: a diagnostic challenge.
        Case Rep Gastrointest Med. 2018; 2018: 7871503
        • Chaudhary A.
        • Negi S.S.
        • Sachdev A.K.
        • Gondal R.
        Pancreatic tuberculosis: still a histopathological diagnosis.
        Dig Surg. 2002; 19: 389-392
        • Panic N.
        • Maetzel H.
        • Bulajic M.
        • Radovanovic M.
        • Löhr J.M.
        Pancreatic tuberculosis: a systematic review of symptoms, diagnosis and treatment.
        United European Gastroenterol J. 2020; 8: 396-402
        • Kim J.B.
        • Lee S.S.
        • Kim S.H.
        • Byun J.H.
        • Park D.H.
        • Lee T.Y.
        • et al.
        Peripancreatic tuberculous lymphadenopathy masquerading as pancreatic malignancy: a single-center experience.
        J Gastroenterol Hepatol. 2014; 29: 409-416
        • Porter A.E.
        The bacteriolytic action of gland extracts on tubercle bacilli.
        J Hyg (Lond). 1917; 16: 55-65
        • Nagar A.M.
        • Raut A.A.
        • Morani A.C.
        • Sanghvi D.A.
        • Desai C.S.
        • Thapar V.B.
        Pancreatic tuberculosis: a clinical and imaging review of 32 cases.
        J Comput Assist Tomogr. 2009; 33: 136-141
        • Sharma V.
        • Rana S.S.
        • Kumar A.
        • Bhasin D.K.
        Pancreatic tuberculosis.
        J Gastroenterol Hepatol. 2016; 31: 310-318
        • Le Bihan D.
        • Iima M.
        Diffusion magnetic resonance imaging: what water tells us about biological tissues.
        PLoS Biol. 2015; 13e1002203