Pancreatic Tuberculosis Diagnosed with Endoscopic Ultrasound-Guided Fine Needle Aspiration: Solid-Cystic Pancreatic Lesions in Endemic Areas

Pancreatic tuberculosis is very rare, especially in immunocompetent patients, and represents a diagnostic challenge. The clinical features in patients with pancreatic tuberculosis are usually nonspecific, and the radiologic features may mimic pancreatic malignancy or pancreatitis. We describe four cases with pancreatic tuberculosis mimicking carcinoma or pancreatic cyst on imaging. None of these patients was immunocompromised. Endoscopic ultrasound-guided fine needle aspiration demonstrated necrotizing granulomatous inflammation in these cases and acid-fast bacilli in two of them. We suggest that pancreatic tuberculosis should be included in the differential diagnosis of a pancreatic cystic or solid-cystic mass, especially in patients from a region where tuberculosis is endemic.