Pancreatic pseudotumor due to peripancreatic lymphadenitis: case report and literature review

Pseudotumor pancreático devido a linfadenite peripancreática: relato de caso e revisão de literatura

Autores

  • Flávio Vecchi Barbosa Júnior Medicine Course, Evangelical University of Goiás (UniEVANGÉLICA), Anápolis (GO), Brazil; Gastromed – Clínica de Gastroenterologia e Medicina Avançada, Anápolis (GO), Brazil https://orcid.org/0009-0007-6434-5437
  • Wilson Jose Sena Pedro Medicine Course, Evangelical University of Goiás (UniEVANGÉLICA), Anápolis (GO), Brazil; Gastromed – Clínica de Gastroenterologia e Medicina Avançada, Anápolis (GO), Brazil https://orcid.org/0009-0008-0192-3292
  • Keyci Shizue Ito Tabata Medicine Course, Evangelical University of Goiás (UniEVANGÉLICA), Anápolis (GO), Brazil; Gastromed – Clínica de Gastroenterologia e Medicina Avançada, Anápolis (GO), Brazil https://orcid.org/0009-0005-5424-833X
  • Lenita Vieira Braga Medicine Course, Evangelical University of Goiás (UniEVANGÉLICA), Anápolis (GO), Brazil; Gastromed – Clínica de Gastroenterologia e Medicina Avançada, Anápolis (GO), Brazil https://orcid.org/0009-0001-0479-0543
  • Fernanda N. B. R. Alves Medicine Course, Evangelical University of Goiás (UniEVANGÉLICA), Anápolis (GO), Brazil; Gastromed – Clínica de Gastroenterologia e Medicina Avançada, Anápolis (GO), Brazil https://orcid.org/0009-0004-3623-0366
  • Larissa Rodrigues Alves Medicine Course, Evangelical University of Goiás (UniEVANGÉLICA), Anápolis (GO), Brazil; Gastromed – Clínica de Gastroenterologia e Medicina Avançada, Anápolis (GO), Brazil https://orcid.org/0009-0002-2333-7362
  • João Pedro R. Afonso Human Movement and Rehabilitation Graduate Program, Evangelical University of Goiás (UniEVANGÉLICA), Anápolis (GO), Brazil https://orcid.org/0000-0002-1392-4910
  • Wilson Rodrigues Freitas Júnior Postgraduate Program in Health Sciences at the Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil. https://orcid.org/0000-0002-8394-3842
  • Adriano Namo Cury Postgraduate Program in Health Sciences at the Faculty of Medical Sciences of Santa Casa de São Paulo (FCMSCSP), São Paulo (SP), Brazil. https://orcid.org/0000-0002-9777-8366
  • Luis Vicente Franco Oliveira Human Movement and Rehabilitation Graduate Program, Evangelical University of Goiás (UniEVANGÉLICA), Anápolis (GO), Brazil

Palavras-chave:

Pancreatic pseudotumor, Pancreatic tuberculosis, Differential diagnosis, Pancreatic resection

Resumo

The pancreas has exocrine and endocrine glandular tissue, the latter accounting for only 1-2% of the gland. Pancreatic disorders are common but difficult to diagnose due to their anatomical location and vague symptoms. Pancreatic pseudotumors are enlarged pancreas without neoplasia and can be mistakenly diagnosed as malignant, complicating treatment. One study demonstrated that 9.2% of pancreatic resections suspected of malignancy were benign. In the clinical case presented, a 35-year-old male patient presented with severe abdominal pain, jaundice, weight loss, as well as fever, nausea, and vomiting. Laboratory tests showed significant changes in liver enzymes, bilirubin, and blood count. The differential diagnosis included lymphoma, tuberculosis, and other pathologies. Laparotomy revealed peripancreatic lymph nodes with caseous necrosis, which were confirmed as tuberculosis. Pancreatic tuberculosis is rare and can be confused with neoplasms due to similar symptoms. Accurate diagnosis requires a high degree of suspicion and methods such as image-guided biopsy. Treatment involves the use of tuberculostatics. In endemic regions, tuberculosis should always be considered in cases of peripancreatic lesions.

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Referências

ABRAHAM, S.C. et al. Pancreaticoduodenectomy (Whipple resections) in patients without malignancy: are they all “chronic pancreatitis”? Am J Surg Pathol, v. 27, n. 1, p. 110-20, 2003.

AUERBACH, O. Acute generalised miliary tuberculosis. Am J Pathol, v. 20, p. 121-36, 1944.

BHANSALI, S.K. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol, v. 67, p. 324-37, 1977.

BHANSALI, S.K. Abdominal tuberculosis. Experiences with 300 cases. Am J Gastroenterol, v. 67, p. 324-37, 1977

FAN, S. et al. Tuberculosis of the pancreas: a rare cause of massive gastrointestinal bleeding. Br J Surg, v. 73, p. 373, 1986.

HADDAD, F.S. et al. Abdominal tuberculosis. Dis Colon Rectum, v. 30, p. 724-735, 1987.

MALLERY, J.S. et al. Pancreatic tissue sampling guided by EUS, CT/US, and surgery: a comparison of sensitivity and specificity. Gastrointest Endosc, v. 56, p. 218-24, 2002.

POMBO, F. et al. Pancreatic tuberculosis: CT findings. Abdom Imaging, v. 23, p. 394-7, 1998.

REDHA, S. et al. Pancreatic tuberculosis presenting with recurrent acute pancreatitis. Med J Malaysia, v. 56, p. 95-7, 2001.

RUNYON, B.A. Textbook of Gastroenterology. 2nd ed. Philadelphia: Lippincott, p. 928, 1995.

SCHAPIRO, R.H.; MAHER, M.M.; MISDRAJI, J. Case records of the Massachusetts General Hospital. Case 3-2006. A 63-year-old woman with jaundice and a pancreatic mass. N Engl J Med, v. 354, p. 398-406, 2006.

SCHNEIDER, A. et al. Two cases of pancreatic tuberculosis in nonimmunocompromised patients. A diagnostic challenge and a rare cause of portal hypertension. Pancreatology, v. 2, p. 69-73, 2002.

SUNDERAM, G. et al. Tuberculosis as a manifestation of the acquired immunodeficiency syndrome (AIDS). JAMA, v. 256, p. 362-6, 1986.

UZUNKOY, A.; HARMA, M.; HARMA, M. Diagnosis of abdominal tuberculosis: Experience from 11 cases and review of the literature. World J Gastroenterol, v. 10, n. 24, p. 3647-3549, 2004.

WEISS, E.; KLEIN, W.; YEO, C. Peripancreatic tuberculosis mimicking pancreatic neoplasia. J Gastrointest Surg, v. 9, p. 254-62, 2005.

XIA, F. et al. Tuberculosis of pancreas and peripancreatic lymph nodes in immunocompetent patients: experience from China. World J Gastroenterol, v. 9, p. 1361-4, 2003.

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Publicado

2024-07-09

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