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Peripancreatic tuberculous lymphadenopathy masquerading as pancreatic malignancy: A single‐center experience
Author(s) -
Kim JiBeom,
Lee Sang Soo,
Kim SungHan,
Byun Jae Ho,
Park Do Hyun,
Lee Tae Yoon,
Lee Byung Uk,
Jeong Seung Uk,
Seo DongWan,
Lee Sung Koo,
Kim MyungHwan
Publication year - 2014
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12410
Subject(s) - medicine , tuberculosis , malignancy , interquartile range , regimen , fine needle aspiration , tuberculous lymphadenitis , retrospective cohort study , radiology , biopsy , surgery , gastroenterology , pathology
Background and Aim Peripancreatic tuberculous lymphadenopathy is very rare and can be misdiagnosed with pancreatic or peripancreatic malignancies. The clinical characteristics and treatment outcome have not been well known. Herein, we investigated the accuracy of endoscopic ultrasound‐guided fine needle aspiration ( EUS‐FNA ), clinical features, and treatment outcomes. Methods We retrospectively analyzed 42 patients diagnosed with peripancreatic tuberculosis between D ecember 2004 and J anuary 2011 at the tertiary care hospital in K orea. Results Median age was 36 years (interquartile range, 30–55), and female was 66.7% (28/42). Nineteen patients (45.2%) had no symptoms, while the others had non‐specific various symptoms. Thirteen (31.0%) had a previous history of tuberculosis. Initial impressions of the mass were pancreatic cancer in 14 (33.3%) and tuberculous lymphadenopathy in 13 patients (31.0%). EUS‐FNA was performed in all 42 patients, with a diagnostic yield of pathologic examinations in 80.5%, polymerase chain reaction for tuberculosis in 42.9%, culture in 47.4%, and acid‐fast bacilli staining in 10.0%. Tuberculosis is confirmed in 28 (66.7%), and probable tuberculosis in 14 (33.3%). All patients received anti‐tuberculosis treatment, a 6‐months regimen in 12 (28.6%) and a 9‐months regimen in 28 (66.7%). Treatment response evaluated in 35 patients (83.3%) by computed tomography criteria showed complete response in 10 patients (28.6%), partial response in 23 (65.7%), stable disease in 1 (2.9%), and progressive disease in 1 (2.9%). Conclusions Peripancreatic tuberculous lymphadenopathy is frequently mistaken for pancreatic malignancy. EUS‐FNA can be helpful for an accurate diagnosis. Complete resolution of the lesion, however, was not common on following imaging study after treatment.