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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 8  |  Issue : 3  |  Page : 309-310

Biopsy or bio-spy? The role of fine-needle aspiration cytology in pancreatic tuberculosis


1 Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
2 Department of Medical, Surgical and Health Science, University of Trieste, Cattinara Hospital, Trieste, Italy

Date of Web Publication12-Sep-2019

Correspondence Address:
Dr Tiziana Salviato
Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Via Del Pozzo 71, 41124 Modena
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmy.ijmy_103_19

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How to cite this article:
Gallo G, Caramaschi S, Mangogna A, Salviato T. Biopsy or bio-spy? The role of fine-needle aspiration cytology in pancreatic tuberculosis. Int J Mycobacteriol 2019;8:309-10

How to cite this URL:
Gallo G, Caramaschi S, Mangogna A, Salviato T. Biopsy or bio-spy? The role of fine-needle aspiration cytology in pancreatic tuberculosis. Int J Mycobacteriol [serial online] 2019 [cited 2019 Sep 20];8:309-10. Available from: http://www.ijmyco.org/text.asp?2019/8/3/309/266484



We have read the interesting paper recently published by Ali et al., March, 8 volume, 1 issue, detailing a case of pancreatic mass in a 40-year-old male presenting with important weight loss, abdominal pain, and fever for 2 weeks. He denied any other complaint, history of tuberculosis, or drugs assumption.[1]

Recently, we have observed a comparable case of pancreatic tuberculosis which in our opinion deserves a short mention, given the rarity of such presentation and the entailed diagnostic clinical and pathologic challenges, especially when dealing with patients coming from endemic areas for tuberculosis.[1]

As Ali et al. properly stressed, despite the high prevalence of tuberculosis in developing countries, a preponderant or exclusive presentation as a pancreatic mass in advanced disease is rather uncommon and cases published in the pertinent literature are limited.[2],[3]

We herein describe of a 30-year-old man from Ivory Coast who has been recently referred to our Hospital complaining of abdominal pain and lack of appetite; he was treated with imatinib for chronic myeloid leukemia about 1 year before. In addition, the past medical history was positive for pulmonary tuberculosis diagnosed and treated 7 years previously. On admission, physical examination was negative for enlarged superficial lymph nodes. He denied weight loss and did not present jaundice. Abdominal ultrasound revealed a slightly enlarged spleen, and computed tomography scan revealed a 1.6 cm solid mass within the pancreatic head [Figure 1]a along to enlarged lymph nodes at the hepatic hilum and celiac tripod. A chest X-ray evidenced pleural effusion. Serum level of carcinoembryonic antigen and CA19.9, as well as pancreatic hormones were negative and routine exams showed leukopenia. His QuantiFERON was positive, but the bronchoalveolar washing was negative. The clinical differential diagnoses favored either a pancreatic localization of chronic myeloid leukemia or a primitive pancreatic neoplasia; hence, a fine-needle aspiration cytology (FNAC) of the mass was performed. The aspirated material was examined by means of the cell-block technique, and microscopic examination of hematoxylin-eosin stained sections showed fibrinoid material, Langhans giant cells, and scattered inflammatory cells [Figure 1]b. Atypical epithelial cells were not recognized, so ductal carcinoma was reasonably excluded. All the other histochemical and immunohistochemical stains were negative. On the overall, the combined microscopic evidence were deemed consistent with pancreatic localization of tuberculosis, and after appropriate therapy, the patient does not report any relapse.
Figure 1: (a) Pancreatic mass at computed tomography scan, (b) fine-needle aspiration cytology: fibrinoid material, with Langhans giant cells (H and E, ×40)

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Although rarely diagnosed,[2],[3] approximately 15%–20% of tuberculosis cases worldwide are extrapulmonary forms and patients may or may not have had active pulmonary disease or history of tuberculosis.

Along to the considerations addressed by Ali et al. in their index paper,[1] we emphasize once again that pancreatic tuberculosis should be considered in the differential diagnosis of a solid pancreatic mass, especially in patients with a history of tuberculosis or in subjects coming from geographic areas where tuberculosis is endemic. Instrumental guided FNAC or biopsy proven useful diagnostic tools especially either in oligo/asymptomatic [4] patients with nonspecific clinical features.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgment

A special thanks to Dr. Luca Reggiani Bonetti, University of Modena (Italy) for the diagnostic support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ali M, Shaukat A, Al-Suwaidi Z, Al-Maslamani M. Tuberculosis of pancreas, the first case reported from Qatar. Int J Mycobacteriol 2019;8:101-3.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Abbaszadeh M, Rezai J, Hasibi M, Larry M, Ostovaneh MR, Javidanbardan S, et al. Pancreatic tuberculosis in an immunocompetent patient: A case report and review of the literature. Middle East J Dig Dis 2017;9:239-41.  Back to cited text no. 2
    
3.
Chaudhary P, Bhadana U, Arora MP. Pancreatic tuberculosis. Indian J Surg 2015;77:517-24.  Back to cited text no. 3
    
4.
Chang MC, Wong JM, Chang YT. Screening and early detection of pancreatic cancer in high risk population. World J Gastroenterol 2014;20:2358-64.  Back to cited text no. 4
    
5.
Atiq M, Suzuki R, Khan AS, Krishna SG, Ridgway TM, Guha S, et al. Clinical decision making in the management of pancreatic cystic neoplasms. Expert Rev Gastroenterol Hepatol 2013;7:353-60.  Back to cited text no. 5
    


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