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
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Article info
Publication history
Published online: October 11, 2021
Accepted:
September 29,
2021
Received:
September 6,
2021
Footnotes
☆Precis: 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.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
