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AIM:To determine the clinical,radiographic and laboratorycharacteristics,diagnostic methods,and therapeutic variablesin immunocompetent patients with tuberculosis (TB) of thepancreas and peripancreatic lymph nodes.METHODS:The records of 16 patients (6 male,10 female;mean age 37 years,range 18-56years) with tuberculosis ofthe pancreas and peripancreatic lymph nodes from 1983 to2001 in the Southwest Hospital were analyzed retrospectively.In addition,58 similar cases published in Chinese literaturewere reviewed and summarized.We reviewed the clinical,radiographic and laboratory findings,diagnostic methods,therapeutic approaches,and outcome in the patients.Criteriafor the diagnosis of pancreatic tuberculosis were the presenceof granuloma in histological sections or the presence ofMycobacterium tuberculosis DNA by polymerase chainreaction (PCR).RESULTS:Predominant symptoms consisted of abdominalnodule and pain (75 %),anorexia/weight loss (69 %1,malaise/weakness (64 %),fever and night sweats (50 %),back pain (38 %) and jaundice (31%).Swelling of thehead of the pancreas with heterogeneous attenuation echowas detected with ultrasound in 75 % (12/16).CT scanshowed pancreatic mass with heterogeneous hypodensityfocus in all patients,with calcification in 56 % (9/16/patients,and peripancreatic nodules in 38 % (6/16)patients.Anemia and lymphocytopenia were seen in 50 %(8/16/patients,and pancytopenia occurred in 13 % (2/16) patients.Hypertransaminasemia,elevated alkalinephosphatase (AP) and GGT were seen in 56 % (9/16/patients.The erythrocyte sedimentation rate (ESR) waselevated in 69 % (11/16/cases.Granulomas were foundin 75 % (12/16) cases,and in 38 % (6/16) cases caseousnecrosis tissue was found.Laparotomy was performed in75 % (12/16/cases,and ultrasound-guided fine needleaspiration (FNA) was done in 63 % (10 of 161.The mostcommonly used combinations of medications wereisoniazid/rifampin/streptomycin (63 %,n=10) andisoniazid/rifampin pyrazinamide/streptomycin or ethambutol(38 %,n=6).The duration of treatment lasted for half orone year and treatment was successful in all cases.Thecharacteristics of 58 cases from Chinese literature werealso summarized. CONCLUSION:Tuberculosis of the pancreas andperipancreatic lymph nodes should be considered as adiagnostic possibility in patients presenting with a pancreaticmass,and diagnosis without laparotomy is possible if onlydoctors are aware of its clinical features and investigate itwith appropriate modalities.Pancreatic tuberculosis can beeffectively cured by antituberculous drugs.
AIM: To determine the clinical, radiographic and laboratory characteristics, diagnostic methods, and therapeutic variables in immunocompetent patients with tuberculosis (TB) of the pancreas and peripancreatic lymph nodes. METHHODS: The records of 16 patients (6 male, 10 female; mean age 37 years, range 18-56years) with tuberculosis of the pancreas and peripancreatic lymph nodes from 1983 to 2001 in the Southwest Hospital were analyzed retrospectively. In addition, 58 similar cases published in Chinese literaturewere reviewed and summarized.We reviewed the clinical, radiographic and laboratory findings, diagnostic methods , RECEPTION approaches, and outcome in the patients. Criteria for the diagnosis of pancreatic tuberculosis were the presence of granuloma in histological sections or the presence of Mycobacterium tuberculosis DNA by polymerase chain reaction (PCR) .RESULTS: Predominant symptoms consisted of abdominal nodule and pain (75%), anorexia / weight loss (69% 1, malaise / weakness (64%), fever and night sweats (50%), back pain (38%) and jaundice (31%). Swelling of the head of the pancreas with heterogeneous attenuation echowas detected with ultrasound in 75% (12/16). CT scanshowed pancreatic mass with heterogeneous hypodensity focus in all patients , with calcification in 56% (9/16 of patients, and peripancreatic nodules in 38% (6 of 16) patients. Anemia and lymphocytopenia were seen in 50% (8 of 16 patients, and pancytopenia occurred in 13% 16) patients. Hypertransaminasemia, elevated alkaline phosphatase (AP) and GGT were seen in 56% (9/16 / patients. Erythrocyte sedimentation rate (ESR) waselevated in 69% (11/16 cases / cases.Granulomas were foundin 75% / 16) cases, and in 38% (6/16) cases of caseousnecrosis tissue was found. Laparotomy was performed in 75% (12/16 cases, and ultrasound- guided fine needle aspiration (FNA) was done in 63% (10 of 161 . The mostcommonly used combinations of medications wereisoniazid / rifampin / streptomycin (63%, n = 10) andisoniazid / rifampin pyrazinamide / streptomycin or ethambutol (38%, n = 6). The duration of treatment lasted for half orone year and treatment was successful in all cases. characterization of 58 cases from Chinese literature wereal summarized. CONCLUSION: Tuberculosis of the pancreas andperipancreatic lymph nodes should be considered as adiagnostic possibility in patients presenting with a pancreatic mass, and diagnosis without laparotomy is possible if onlydoctors are aware of its clinical features and investigate itwith appropriate modalities. Pancreatic tuberculosis can be beffectively cured by antituberculous drugs.