Pancreatic cyst-solid mass: tuberculosis

Question: A 29-year-old Chinese male was admitted to our department with a history of right upper quadrant pain for two months, anorexia, weight loss about 5 kg and without fever. The pain radiated to the back and it got worst lately. He didn’t have a history of tuberculosis. The sclera was mild icteric. Laboratory test results showed total bilirubin level increased to 58 umol/L (normal level <28 umol/L) and tumor markers were normal. Chest X-ray was normal. Abdominal contrastenhanced CT showed a 25 x 30 mm cyst-solid mass in the head of pancreas (Figure1. A) and the lesion was mild enhancement in arterial phase. Pancreatic tumor was considered. Endoscopic ultrasonography confirmed the mass with uneven echo in the pancreatic head and the boundary of the mass was not clear (Figure1. B). The lesion may invade the portal vein. As the patient was young and the operation was very traumatic, the patient refused surgery unless the lesion was proved to be a tumor.

Keywords: tuberculosis, cyst-solid mass.