Clinical Features and Diagnosis of Pancreatic Tuberculosis

  Objective  To explore the clinical features and key points in diagnosis of pancreatic tuberculosis.

  Methods  The clinical manifestations, auxiliary tests, and diagnosis of inpatients confirmed as pancreatic tuberculosis in Peking Union Medical College Hospital in the period from January 1984 to March 2014 were retrospectively analyzed.

  Results  There were 10 cases of pancreatic tuberculosis diagnosed in the study period, accounting for 0.12%(10/8689) of the total tuberculosis patients diagnosed at the same period. The 10 patients included 5 males and 5 females; aged 53.1 years on average (31-70 years), with 80% below the age of 65. The most common symptoms were abdominal pain (60%), anorexia (60%) and weight loss (60%). Fever(40%) and jaundice(10%) were less common, while night sweat was absent. CT and PET/CT failed to make the diagnosis of pancreatic tuberculosis. In one case, intestinal tuberculosis was found after positive result of purified protein derivative test. In another case with cold abscess at the neck, a clinical diagnosis of tuberculosis was made and later confirmed by response to anti-tuberculosis therapy. Tuberculosis was confirmed in one case by pretibial nodule autopsy result, another by ultrasound-guided pancreatic nodule needle autopsy. In the other 6 cases, pathological examination after laparotomy confirmed the diagnosis of tuberculosis.

  Conclusions  Pancreatic tuberculosis is rare. It may present as regional cystic or solid pancreatic masses and often be misdiagnosed as pancreatic tumors, leading to surgery. History and symptoms are the first key clues in diagnosis. Imaging is helpful, while confirmed diagnosis is made based on pathological results. For young patients with signs of infection, having pancreatic masses with negative tumor markers, with or without retroperitoneal enlarged lymph nodes, pancreatic tuberculosis should be considered. Endoscope-or ultrasound-guided biopsy is needed in patients hard to identify, and laparotomy may be used when necessary.