Vascular invasion does not discriminate between pancreatic tuberculosis and pancreatic malignancy: a case series

BACKGROUND: Pancreatic tuberculosis is very rare and most commonly involves the head and uncinate process of the pancreas. It closely mimics pancreatic malignancy and is often diagnosed after pancreatico-duodenectomy. Vascular invasion is believed to be a hallmark of malignant lesions and described as a point of differentiating benign lesions from malignant lesions. We herein retrospectively evaluated the patients with pancreatic tuberculosis seen at our unit over the last 4 years for features of vascular invasion. METHODS: We retrospectively analyzed the collected database of all patients diagnosed with pancreatic tuberculosis at our unit over the last four years and identified patients who had evidence of local vascular invasion and their clinical and imaging findings were retrieved. RESULTS: Over the last four years, 16 patients (12 males) with pancreatic tuberculosis were seen and five of these 16 patients had imaging features of vascular invasion by the pancreatic head mass. Of these five patients, four were males and the mean age was 32.0±5.47 years. Of these five patients, three had involvement of portal vein and superior mesenteric vein and two had involvement of hepatic artery. CONCLUSION: Presence of vascular invasion does not distinguish pancreatic tuberculosis and malignancy, and, therefore, cytopathological confirmation is mandatory to differentiate between the two.