Vishal Sharma, Surinder S Rana and Deepak K Bhasin
Department of Gastroenterology, Post Graduate Institute of Medical Education and Research (PGIMER). Chandigarh, India
Received May 27th, 2013 - Accepted July 15th, 2013
Endosonography; Pancreas; Tuberculosis
We read with great interest the series of five cases of pancreatic tuberculosis diagnosed by endoscopic ultrasound guided fine needle aspiration (EUS-FNA) from an occidental country . Pancreatic tuberculosis is very rare, even in endemic countries, and most commonly involves the head and uncinate process of the pancreas and its clinical and radiological findings often mimic pancreatic malignancy [2, 3, 4]. Endoscopic ultrasound (EUS) is an accurate diagnostic modality for diagnosis of pancreatic lesions including pancreatic tuberculosis and EUS-FNA provides an opportunity to diagnose and medically treat this disease which could otherwise result in a complex and unnecessary surgery [2, 3, 4].
We also had published our experience of 6 patients of isolated pancreatic head tuberculosis seen over a period of two years at a tertiary care center in North India and found that on EUS, it presents as a well defined hypoechoic mass lesion with none of the patients having any anechoic areas or calcification within the mass lesions . We also found that whenever positron emission tomography (PET) is done in these patients, these lesions have been found to be flourodeoxyglucose (FDG) avid [4, 5].
Moreover, EUS FNA established diagnosis in all the patients with granulomas being noted in 5 out of 6 (83.3%) patients. Acid fast bacilli were seen in only 1 out of 6 (16.7%) and culture for Mycobacterium tuberculosis was positive in 1 of 2 patients (50.0%) tested.
In conclusion, as none of the EUS features are distinctive for diagnosis of pancreatic tuberculosis, EUS FNA and tissue sampling for staining, cytology, culture and polymerase chain reaction assay is essential for establishing the diagnosis of pancreatic tuberculosis.
No financial disclosures and no conflicts of interest of any author