PANCREATIC TUBERCULOSIS MIMICKING PANCREATIC NEOPLASM

Known as the “Great Imitator,” tuberculosis (TB) presents with numerous manifestations that resemble several different pathologies. In this sense, pancreatic TB is a condition that is difficult to diagnose, mainly due to its clinical and radiological similarities to pancreatic carcinoma. This case report presents a rare manifestation of TB, whose occurrence is favored by the existence of endemic areas with a high number of reported cases, such as Brazil. We report the case of a 41-year-old patient, asymptomatic and with a normal physical examination, whose radiological findings showed a nodular lesion with heterogeneous formation suggestive of malignancy. Based on these results and after formulating the diagnostic hypothesis of pancreatic cancer, additional complementary tests were requested, such as endoscopic ultrasound with fine-needle aspiration, which revealed a peripancreatic lesion with thick cystic content, and aspiration with conclusive results for TB. Complete blood count, coagulation tests, amylase, lipase, CA 19-9, carcinoembryonic antigen (CEA), and chromogranin A showed normal results. In addition, to rule out infections, complete blood count, CRP, ESR, bacterioscopy, AFB smear, fungal tests and cultures were requested, all with normal results. The patient had to undergo exploratory laparotomy due to the considerable size of the lesion and diagnostic uncertainty. After duodenopancreatectomy, the material was sent for histopathological examination, which revealed negative findings for neoplastic cells, cellular proliferation with marked necrosis, and chronic granulomatous inflammatory infiltrate with a tuberculoid pattern, clarifying the patient’s diagnosis: tuberculosis of the pancreatic head. Antitubercular therapy was then initiated, with radiological improvement and gradual regression of the lesion. Final comments : Pancreatic tuberculosis is a rare condition that requires diagnostic suspicion when a pancreatic lesion is present. In the absence of diagnosis and treatment in asymptomatic patients, disease reactivation may occur in a more severe form due to possible exposure to immunosuppression. This highlights the importance of early diagnosis as a means of preventing any manifestation of the disease. Diagnosis can be made mainly through biopsy guided by ultrasonography, computed tomography, or endoscopic ultrasound.