Chuabio Vernon, Bandoy Johanna, Ong Aaron, Te Mateo, Maralit Ruter
Division of Gastroenterology, Department of Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
SAGE Open Med Case Rep. 2024 Jun 17;12:2050313X241262192. doi: 10.1177/2050313X241262192. eCollection 2024.
Pancreatic masses are commonly encountered in clinical practice, with concern for the possibility of cancer. Tissue sampling or outright surgical resection may be offered in this setting. However, surgery has been unnecessarily performed in patients with pancreatic masses that proved to be benign. Less invasive options for pancreatic masses that may be benign like tuberculosis should thus be explored. Three adult Filipino patients less than 60 years old presented with symptomatic pancreatic masses suspected of cancer on abdominal imaging studies. Two were smokers without a history of prior tuberculosis. Without any tissue sampling, anti-tuberculosis treatment was eventually given to all three patients due to concomitant diagnoses of extrapancreatic tuberculosis. Endoscopic ultrasound documentation of post-treatment resolution of pancreatic masses was noted in all cases. In endemic regions, although clinical diagnosis of tuberculosis may be possible for pancreatic masses, empiric treatment should still be a last-line option in cases where tissue sampling cannot be done.
胰腺肿块在临床实践中很常见,人们担心其有癌变的可能。在这种情况下,可能会进行组织取样或直接手术切除。然而,对于经证实为良性的胰腺肿块患者,不必要地进行了手术。因此,应该探索对可能为良性的胰腺肿块(如结核)采用侵入性较小的治疗方案。三名年龄小于60岁的成年菲律宾患者,腹部影像学检查显示有疑似癌症的有症状胰腺肿块。其中两名是吸烟者,无既往结核病史。在未进行任何组织取样的情况下,由于同时诊断出胰腺外结核,最终对所有三名患者都给予了抗结核治疗。所有病例均记录到内镜超声显示胰腺肿块经治疗后消退。在流行地区,虽然胰腺肿块有可能临床诊断为结核,但在无法进行组织取样的情况下,经验性治疗仍应作为最后一线选择。