Authors: Kazuki Ueda Hideyuki Tamai Momoyo Matsumoto Hiroki Maeda Kazuyuki Nakazawa Kosaku Moribata Naoki Shingaki Hisanobu Deguchi Izumi Inoue Takao Maekita Mikitaka Iguchi Kimihiko Yanaoka Masashi Oka Masao Ichinose
Publish Date: 2010/04/06
Volume: 3, Issue: 3, Pages: 159-164
Abstract
A 79yearold woman complaining of epigastric pain was examined by her local physician who found an abdominal mass and referred the patient to our department Abdominal plain computed tomography revealed a mass 50 mm in size with slight calcification on the ventral side of the head of the pancreas On abdominal ultrasound the mass lesion consisted of an aggregation of hypoechoic masses with a heterogeneous hyperechoic region at its center On contrast ultrasonography only the hyperechoic region was stained 18FFluorodeoxyglucosepositron emission tomography FDGPET revealed FDG accumulation in the same region It was difficult to differentiate between a malignant pancreatic tumor and an inflammatory disease on imaging but since QuantiFERON TB2G testing was positive pancreatic tuberculosis was suspected and endoscopic ultrasoundguided fineneedle aspiration biopsy EUSFNA was performed to obtain a definitive diagnosis Samples from the hypoechoic region consisted of necrotic tissue while those from the hyperechoic region consisted of pancreatic tissue together with granulation tissue BCG immunostaining was positive and a diagnosis of pancreatic tuberculosis was made If EUSFNA is performed on stained areas seen on contrast ultrasonography this will probably enable a more accurate diagnosis of pancreatic tuberculosis with low invasiveness
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