Case Report Pancreatology 2002;2:561–564 DOI: 10.1159/000066097 Pancreatic Pseudotumor due to Peripancreatic Tuberculous Lymphadenitis Mustafa Turan a Metin S ¸en a Ayhan Koyuncu a CengizAydin a Nazif Elaldi b Sema Arici c Departments of a General Surgery, b Infectious Diseases, and c Pathology, Cumhuriyet University Faculty of Medicine, Sivas, Turkey Mustafa Turan, MD Department of General Surgery Cumhuriyet University Faculty of Medicine TR–58140 Sivas (Turkey) Tel. +90 346 2250434, Fax +90 346 2262162, E-Mail mturan_1999@yahoo.com ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2002 S. Karger AG, Basel and IAP 1424–3903/02/0026–0561$18.50/0 Accessible online at: www.karger.com/pan Key Words Peripancreatic tuberculous lymphadenitis W Pancreatic tuberculosis W Pancreatic carcinoma Abstract Peripancreatic tuberculous lymphadenitis is a very rare and difficult diagnosis. We report herein a patient with a clinically solitary abdominal tuberculoma. A 68-year-old woman was admitted to our hospital with moderate-lev- el obstructive jaundice due to a mass located between pylorus and head of the pancreas. There were no clinical signs or symptoms of tuberculosis in lungs or abdomen. After the diagnosis of a neoplasm of the pancreas was made, exploratory laparotomy was performed which revealed a conglomerated mass penetrating into the pancreas. Since an exact diagnosis could not be reached on the basis of frozen sections prepared during the oper- ation, a standard Whipple procedure was performed. After the histopathological examination of the resected specimen revealed tuberculous lympadenitis, the patient was given antituberculous medication. The patient re- covered well. An abdominal tuberculoma is often mistak- en for a malignant neoplasm, and nonsurgical diagnosis and treatment of this entity continues to be a challenge. Copyright © 2002 S. Karger AG, Basel and IAP Introduction Tuberculosis is a common illness in developing coun- tries. Although the involvement of liver, spleen, bowel, and mesenteric lymph nodes is common in miliary tuber- culosis, peripancreatic lymph node involvement is ex- tremely rare [1]. Its occurrence may pose a diagnostic problem in differentiating it from a carcinoma of the pan- creas and pancreatitis. Here we report a case with tuber- culosis of a peripancreatic lymph node who had moder- ate-level obstructive jaundice. Case Report A 68-year-old woman presented with cramping abdominal pain and a history of nausea and vomiting for 2 months. The abdominal pain was intermittent and periumbilical, occasionally this pain was worsening after eating, and there were no relieving factors. The hemoglobin concentration was 10.2 g/dl, the white blood cell count 12,900/mm 3 , the platelet count 198,000/mm 3 , the blood sugar con- centration128 mg/dl, the blood urea nitrogen level 14 mg/dl, and the creatinine concentration was 1 mg/dl. The serum potassium level was 4.5 mEq/l and the serum sodium concentration 146 mEq/l. Her con- jugated bilirubin level was 3.9 mg/dl and the unconjugated bilirubin concentration 0.7 mg/dl. Total serum protein was 7.0 g/dl, albumin 4.4 g/dl, alkaline phosphatase 345 IU/l, serum aspartate aminotrans- ferase 130 IU/l, and alanine aminotransferase 144 IU/l. The serum amylase concentration was 109 U/dl. The tumor markers CEA and CA 19-9 were within the normal range. HIV 1 and HIV 2 antibodies