PMC5478565_01
Contrast-enhanced computed tomography image of the abdomen showing a 25-mm low-density mass-like lesion in the pancreas head (arrow).
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Computed tomography (CT) was performed to investigate the cause of the fever and inadvertently revealed a 25-mm mass-like lesion in the pancreas head (Fig. 1).
Diffusion magnetic resonance image of the abdomen showing a high-intensity signal at the pancreas head (arrow).
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The lesion showed a high-intensity signal on diffusion magnetic resonance imaging (MRI) (Fig. 2).
Endoscopic ultrasound image showing a hypoechoic and heterogeneous peripancreatic lesion (arrow).
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Using a 22-gauge fine-needle aspiration (FNA) needle (SonoTip(R) Pro Control; Medi-Globe GmbH, Achenmuhle, Germany), we performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the peripancreatic hypoechoic and heterogeneous lesion (Fig. 3).
Photomicrograph of a histological section of a specimen obtained via ultrasound-guided fine-needle aspiration involving a peripancreatic lesion showing necrotic tissue without malignant cells (200x with Hematoxylin and Eosin staining).
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Aspiration biopsy cytology via EUS-FNA was class II; a histological analysis revealed necrotic tissues without malignant cells or Langhans giant cells (Fig. 4).
Positron emission tomography-computed tomography image showing abnormal uptake of FDG-PET in the left supra-clavicular lymph node and the peripancreatic lesion (arrows).
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On positron emission tomography (PET)-CT, there were the lesions with abnormal uptake of fluorodeoxy glucose (FDG)-PET in the left supra-clavicular lymph node and the peripancreatic lesion (Fig. 5).
A photomicrograph of a histological section of a biopsy specimen obtained from the left supra-clavicular lymph node showing an epithelioid cell granuloma with caseous necrosis and Langhans giant cells (arrows) (100x with Hematoxylin and Eosin staining).
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A whole biopsy of the left supra-clavicular lymph node was performed by an otolaryngologist, and a tuberculous granuloma with caseous necrosis was found (Fig. 6).
A positive response to the polymerase chain reaction indicating tuberculosis in the peripancreatic tissue.
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PCR of the peripancreatic tissue obtained via EUS-FNA was also positive for TB (Fig. 7).