Pancreatic tuberculosis: Likely originating from peripancreatic tuberculous lymphadenitis.

BACKGROUND: Pancreatic tuberculosis is a rare entity. Most cases of pancreatic tuberculosis are documented in case reports. There has been no systematic analysis of the imaging characteristics of pancreatic tuberculosis, its association with abutting peripancreatic tuberculous lymphadenopathy, and its likely pathogenesis. DATA SOURCES: A comprehensive search of pancreatic tuberculosis literature was conducted in MEDLINE, Embase and Scopus from 1978 to 2024. Manual searches of references in the published literature were also performed. The inclusion criteria for eligible cases comprised patient demographics, symptoms, imaging, pathology, microbiology, treatment and outcomes. RESULTS: A total of 252 eligible patients with pancreatic tuberculosis were identified, including 8 (3.2%) associated with miliary tuberculosis and 244 (96.8%) associated with non-miliary tuberculosis. Because the pathogenesis of miliary tuberculosis was distinct and hematogenous dissemination, only the 244 non-miliary tuberculosis patients were analyzed. Among these 244 patients, 61.5% were diagnosed in Asia and 69.2% younger than 50 years. The common symptoms were epigastric pain (79.5%) and weight loss (57.4%). In 244 patients, the most common imaging finding was a solitary mass (94.3%), with 84.8% occurring in the pancreatic head/uncinate process. The predominant imaging findings were heterogeneous lesions with ill-defined borders (77.7%), intralesional hypoechoic/anechoic areas on ultrasound (84.8%), and intralesional low-attenuation areas on contrast-enhanced computed tomography (CT) (86.4%). Peripancreatic tuberculous lymphadenopathies abutting pancreatic tuberculous lesion were observed in 89.3% of 244 patients. Pancreatic tuberculous lesions closely associated with peripancreatic abutting lymphadenopathy, observed in 198 (81.1%) patients. Among 95 patients who underwent surgery, 59 were found to be directly derived from their abutting lymphadenopathies. CONCLUSIONS: Only a small proportion of patients with pancreatic tuberculosis are related to miliary tuberculosis. Pancreatic tuberculosis is more likely to originate from peripancreatic tuberculous lymphadenitis.