PRIMARY PANCREATIC TUBERCULOSIS MIMICKING PANCREATIC LYMPHOMA IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT

The medical discovery of a pancreatic mass has traditionally been associated with a short list of differential diagnosis most often representing an ominous prognosis of pancreatic malignancy. Historically, the possibility of pancreatic tuberculosis (PTB) has not been considered because the medical consensus, as stated by Hari et al[1] and Singh et al[2] believed that pancreatic enzymes were inhibitory to the seeding of tubercle bacilli. Our clinical experience agrees with recent scientific literature showing primary pancreatic manifestation of Mycobacterium Tuberculosis (MTB) do occur and presents as a solitary lesion with multiple cystic components in the head, body or tail of the pancreas. The physiological presentation, as described by Rana et al[3] and Sahani et al[4] mimics 90% of primary cystic pancreatic tumors covered by the three entities, serous or mucinous cystadenoma and intraductal papillary mucinous neoplasm. Its gross appearance is indistinguishable from the pancreatic neoplasms. Literature by both Ladas et al[5] and Hong et al[6] agree that PTB displays no radiographic features which are pathognomonic for its diagnosis. Despite the atypical presentation, scientific literature suggests Mycobacterium possesses the molecular capability for a wide variety of infectious mechanisms including primary PTB. This is a curable disease which warrants clinical investigation and should be included in the list of differentials to prevent erroneous diagnosis of pancreatic malignancy and the unnecessary morbidity of surgery.