Clinical Analysis of Pancreatic Tuberculosis Misdiagnosed as Pancreatic Tumor and Literature Review

LIU Li; FANG Dong; ZHANG Xiaoying; DONG Xiaojuan; ZHANG Ning; WANG Kewen

doi:10.3969/j.issn.1002-3429.2025.07.002

Abstract：Objective To investigate the causes and preventive measures of pancreatic tuberculosis misdiagnosed as pancreatic tumors.Methods The clinical data of 2 patients with misdiagnosed pancreatic tuberculosis from January 2021 to January 2023 were retrospectively analyzed,and the relevant literature was reviewed.Results One patient presented with re-current upper abdominal pain for more than 20 d.Abdominal ultrasound,upper abdominal enhanced CT and magnetic reso-nance imaging were performed,and the initial diagnosis was pancreatic tumor.One patient presented with recurrent right up-per abdominal pain for more than 3 months,which was aggravated for 1 week.Upper abdominal enhanced CT examination was performed,and the initial diagnosis was pancreatic tumor.Both patients had surgical indications and underwent pancreaticodu-odenectomy.In 1 patient,a mass was found in the pancreatic head during intraoperative exploration,rapid frozen pathology showed granuloma and necrosis,and routine pathology suggested tuberculosis.Caseous necrosis and rice-like nodules in the pancreatic parenchyma were found in 1 patient during operation,rapid frozen pathology indicated tuberculosis,and the T-spot test for tuberculosis was positive after operation.Both patients were diagnosed with pancreatic tuberculosis,and the misdiagno-sis lasted 25 d and 104 d,respectively.Both patients received systemic anti-tuberculosis treatment and were discharged after the condition was improved.After 1 year of follow-up,all patients were cured.Conclusion Pancreatic tuberculosis is rare in clinical practice,and its clinical and imaging manifestations are lack of specificity,which is more likely to be misdiagnosed.Careful inquiry about the patient's history of tuberculosis and the use of endoscopic ultrasound-guided fine needle aspiration bi-opsy before surgery can be used to confirm the diagnosis,and avoid the occurrence of misdiagnosis and mistreatment.