case report Gut and Liver, Vol. 5, No. 4, December 2011, pp. 536-538 Coexistence of Pancreatic Carcinoma and Pancreatic Tuberculosis: Case Report Zhen-Jiang Zheng, Hao Zhang, Guang-Ming Xiang, Jun Gong, Gang Mai, and Xu-Bao Liu Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, China Pancreatic tuberculosis (TB) is extremely rare and mimics pancreatic carcinoma both clinically and radiologically. This paper discusses the occurrence of 2 heterogeneous masses located in the head and tail of the pancreas in an adult male. In this patient, laparotomy was performed because of the high suspicion of pancreatic carcinoma. Intraoperative fine needle aspiration biopsy revealed the coexistence of pancreatic carcinoma with pancreatic TB, and a combined resection of the distal pancreas and spleen was successfully performed. Following surgery, the patient received standard chemotherapy for TB. At 7-month follow-up, computed to- mography showed resolution of the mass in the pancreatic head. Clinicians must maintain a high index of suspicion for pancreatic TB in patients with pancreatic masses. The coex- istence of malignancy and TB should be considered when patients present with multiple pancreatic masses. (Gut Liver 2011;5:536-538) Key Words: Fine needle aspiration biopsy; Laparotomy; Pan- creatic carcinoma; Pancreatic mass; Pancreatic tuberculosis INTRODUCTION The incidence of tuberculosis (TB) has significantly increased worldwide. Extrapulmonary TB most commonly affects the intestines, peritoneum, meninges, urogenital system, bone, and lymph nodes; rarely is it found in the pancreas.1 Based on the clinical manifestations and imaging studies, it can be difficult to differentiate pancreatic TB from pancreatic carcinoma. The coexistence of pancreatic carcinoma with pancreatic TB has not been reported previously in the database. This paper presents such a case of pancreatic carcinoma coexisting with pancreatic TB in an adult male patient. CASE REPORT A 34-year-old man was admitted to our hospital with a 1-month history of vague epigastric pain. His review of sys- tems was otherwise unremarkable. He denied exposure to TB or a personal history of TB. On physical examination, epigastric tenderness was present, however no mass was palpated. Labora- tory examination showed: hemoglobin 10.9 g/dL, platelet count 325×109/L, white blood cell count 8.68×109/L, aspartate amino- transferase 21 IU/L (normal, <46 IU/L), alanine aminotransferase 15 IU/L (normal, <55 IU/L), total bilirubin 5.1 μmol/L (normal, 5.0 to 28.0 μmol/L), direct bilirubin 1.6 μmol/L (normal, <8.8 μmol/ L), and CA19-9 157.80 U/mL (normal, <22 U/mL). Human im- munodeficiency virus (HIV) serology was negative. Chest X-ray was normal. Abdominal contrast-enhanced spiral computed tomography (CT) showed a hypodense mass in the head of the pancreas Fig. 1. A contrast-enhanced computed tomography scan shows 2 heterogeneous masses in the head and tail of the pancreas. Correspondence to: Xu-Bao Liu Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China Tel: +86-28-85422477, Fax: +86-28-85164035, E-mail: xbliu@medmail.com.cn Received on May 24, 2010. Revised on July 7, 2010. Accepted on July 27, 2010. pISSN 1976-2283 eISSN 2005-1212 http://dx.doi.org/10.5009/gnl.2011.5.4.536 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.