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Pancreatic Tuberculosis with Markedly Elevated CA 19-9 Levels: A Diagnostic Pitfall
Manveen Kaur1, Varsha Dalal1, Amar Bhatnagar2
1National Institute of Pathology, ICMR, New Delhi, India.
Oman Medical Journal
|December 16, 2016
Summary
Isolated pancreatic tuberculosis (TB) is rare, especially in immunocompetent individuals. This case highlights the importance of considering TB in pancreatic lesions, even with elevated cancer antigen 19-9 (CA 19-9) levels mimicking malignancy.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Oncology
Background:
- Tuberculosis (TB) is prevalent globally, but isolated pancreatic involvement is uncommon.
- Pancreatic TB often presents with nonspecific symptoms, clinically and radiologically resembling pancreatic cancer.
- Diagnosis typically requires cytologic or histologic confirmation.
Observation:
- A 25-year-old male presented with a pancreatic mass and significantly elevated serum cancer antigen 19-9 (CA 19-9) levels.
- Clinical and radiological findings raised strong suspicion for pancreatic malignancy.
- Histopathological examination revealed tuberculosis, not malignancy.
Findings:
- The case demonstrates that pancreatic TB can mimic pancreatic cancer, even with elevated tumor markers like CA 19-9.
- Histopathology is crucial for differentiating pancreatic TB from pancreatic adenocarcinoma.
- Early diagnosis and treatment of pancreatic TB are essential.
Implications:
- Clinicians should maintain a high index of suspicion for pancreatic TB in patients with pancreatic lesions, irrespective of tumor marker status.
- Appropriate diagnostic workup, including histopathology, is vital for accurate diagnosis.
- Prompt initiation of antitubercular therapy is recommended for confirmed cases of pancreatic TB.
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