A rare case of pancreatic tumor

Case: A 65-years old male visited his GP because of abdominal pain and significant weight loss (10 kg) the last three months. He had a medical history of hypertension and dyslipidemia. Clinical examination was unremarkable except for mild epigastric tenderness. Blood tests with complete blood count, liver function test, renal function and coagulation profile were within normal limits. The GP requested an abdominal CT scan which showed a heterogeneous mass lesion in the head of pancreas measuring 3.5 x 3.9 x 2.6 cm and enlarged lymph nodes in the abdomen. Blood tumor markers were normal. The patient was referred to our department for endoscopic ultrasound (EUS).

Findings: EUS showed a hypoechoic mass in the head of pancreas and mild enlargement of regional lymph nodes. Fine needle biopsy of the pancreatic tumor through EUS was performed and the histologic examination was negative for cancer. The findings were explained to the patient. He was very concerned that he might have cancer and after discussion with surgeons he was keen to have operation. The plan was to proceed with Whipple’s operation only if a tumor biopsy with rapid on site evaluation (ROSE) during surgery came back positive for cancer. The patient was scheduled for surgery but ROSE during surgery was negative for cancer and therefore the surgeon did not proceed with Whipple’s operation. Further histologic examination of the tissue sample showed epithelioid granulomas surrounded by lymphocytic infiltrates. Ziehl-Neelsen stain was positive for acid-fast bacilli, hence, diagnosis of tuberculosis was made and anti-tubercular treatment started.

Publication History

Article published online:
27 March 2025