Isolated pancreatic tuberculosis diagnosed by endoscopic ultrasound-guided fine needle aspiration: a case report.

CONTEXT: Pancreatic tuberculosis is an extremely rare clinical entity, despite the high prevalence of tuberculosis worldwide. The pancreas is protected from direct environmental exposure; therefore most cases of pancreatic tuberculosis arise from contiguous infection from peri-pancreatic lymph nodes or rarely from hematogenous spread. Pancreatic tuberculosis can present as a cystic or solid pancreatic mass mimicking pancreatic malignancy. Diagnosing pancreatic tuberculosis is a clinical challenge and most cases are diagnosed after surgical exploration for presumed pancreatic cancer. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is being used more frequently for imaging and sampling of pancreatic lesions. Immediate cytopathologic examination of tissue sampled by EUS increases the diagnostic yield and is standard in many institutions. CASE REPORT: Herein, we describe the case of a woman with a pancreatic mass subsequently diagnosed with pancreatic tuberculosis via EUS-FNA. Intraprocedural immediate cytologic evaluation prompted samples to be sent for appropriate microbiological culture.
CONCLUSION: This case demonstrates the importance of real-time on-site cytopathology input during EUS-FNA procedures.