11. Fiorentino DF, Nguyen JC, Egbert BM, et al. Muir-Torre syndrome: con- firmation of diagnosis by immunohistochemical analysis of cutaneous lesions. J Am Acad Dermatol 2004;50:476-7. 12. Ponti G, Ponz de Leon M, Losi L, et al. Different phenotypes in Muir-Torre syndrome: clinical and biomolecular characterization in two italian families. Br J Dermatol 2005;152:1335-8. 13. Mencia-Gutierrez E, Santos-Briz A. Sebaceous gland carcinoma of the eyelid and palpebral conjunctiva in a patient with Muir-Torre syndrome. Br J Opthalmol 2000;84:1325-6. Geisinger Medical Center, Danville, Pennsylvania, USA. Reprint requests: Duane E. Deivert, DO, Geisinger Medical Center, Department of Gastroenterology (MC 21-11), 100 N Academy Ave, Danville, PA 17822. Copyright ª 2008 by the American Society for Gastrointestinal Endoscopy 0016-5107/$32.00 doi:10.1016/j.gie.2007.12.025 Isolated pancreatic tuberculosis mimicking intraductal pancreatic mucinous tumor Vikram Bhatia, MD, DM, Pramod Kumar Garg, MD, DM, Vinod Kumar Arora, MD, Raju Sharma, MD New Delhi, India Isolated pancreatic tuberculosis is a rare disease, and only isolated cases and small series have been reported in the literature. We present a case of pancreatic tuberculosis that closely mimicked intraductal papillary mucinous tumor (IPMT) on imaging. EUS with FNA was used to establish the diagnosis. CASE REPORT A 36-year-old man presented with complaints of continu- ous epigastric pain for the past 7 months. The pain was un- related to meals and was nonradiating. The patient did not have fever, weight loss, or jaundice. His appetite was nor- mal. He had been treated for pulmonary tuberculosis 4 years earlier. Results of physical examination were unre- markable. Investigation showed hemoglobin of 13.2 g/dL (reference range, 13.2-16.2 g/dL), total leukocyte count of 10,500/ mL (4000-11,000 mL) with a normal differential, erythrocyte sedimentation rate of 20 mm/first hour (0-17 mm/first hour), total bilirubin of 0.7 mg/dL (0.8-1.0 mg/ dL), alanine-aminotransferase of 68 U/L (up to 50 U/L), alka- line phosphatase of 225 U/L (80-240 U/L), and albumin of 4.1 g/L (4.0-5.5 g/L). Results of HIV serology were negative, and results of chest radiograph were normal. A CT scan one month after the onset of pain showed a hypodense, lobu- lated lesion 4 cm in diameter in the head of the pancreas, with subtle peripheral enhancement (Fig.1). CT-guided FNA from the mass showed only normal acinar cells. We per- formed MRCP 6 months after the initial CT scan, which showed a cluster of well-defined cysts in the head and prox- imal body of the pancreas, with few enhancing nodules in- side the cysts. The main pancreatic duct was not dilated. There was a subcapsular enhancing lesion in the right liver lobe. The imaging features were suggestive of branch-duct- type IPMT (BDT-IPMT), with liver metastasis. The patient underwent EUS examination with the Pentax EG-3830UT linear echoendoscope. A multicystic mass was seen in the head and body of the pancreas with side-branch communication and without internal Doppler signals (Fig. 2). The main pancreatic duct was normal. EUS-guided FNA was done from the cyst, which yielded thick whitish ma- terial. A total of 3 passes were made with Mediglobe 22G FNA needle (Medizen Tecknik, Germany). Papanicolaou- stained smears showed acellular necrosis. No tumor cells or mucin were seen. In view of prominent necrosis, the smears were destained by methanol and then restained by Ziehl-Neelsen (ZN) stain. ZN-stained smears showed a large number of 3- to 8-mm-long, acid-fast bacilli with a delicate beaded appearance (Fig. 3). The patient began 4-drug anti- tuberculous therapy. After 8 months’ follow-up he was pain Figure 1. Contrast-enhanced CT scan showing a hypodense, lobulated lesion in head of pancreas with subtle peripheral enhancement. A small hypodense lesion is seen in the right liver lobe. 610 GASTROINTESTINAL ENDOSCOPY Volume 68, No. 3 : 2008 www.giejournal.org Brief Reports