ISOLATED TUBERCULOSIS OF PANCREAS AND PERIPANCREATIC LYMPH NODES: DIAGNOSIS CHALLENGE

Abstract

Background : Isolated tuberculosis of pancreas and peripancreatic lymphnodes is very rare and difficult to recognise. It may mimic pseudocyst, cystic tumor or carcinoma of pancreas and lead to unusefull and potentially morbid surgery.
Aim :We report 3 cases diagnosed in peropeative and postoperative situations.
Cases :Thirty four- year-old and 50-year-old women presented with obstructive jaundice. Abdominal CT scan showed resecable head of pancreas tumour. In first patient, peroperative biopsies suggested tuberculosis and resection was avoided. The second patient underwent Whipple procedure. Third case was a 48-year-old alcoholic man who presented with recent history of painful mass of left hypochondre. Cystic tumor of pancreas tail and pseudocyst were suggested in CT scan. En bloc resection of tumor, pancreas tail and spleen was performed. The three patients had antitubercular therapy after histological confirmation of pancreatic tuberculosis. Follow-up is respectively 3 years, 5 months and 2 years free of recurrence.
Conclusion : Radio or echoendoscopical fine needle ponction can contribute to the diagnosis. Surgery remains the main treatment of complications (fistulas, bleedings, obstructions) and the last diagnosis option. Tuberculous origin of an isolated pancreatic mass may be suspected in young people and  immunocompromised especially in endemic areas.