A rare case of pancreatic tail tuberculosis and literature review: a case report.

Introduction and importance: Pancreatic lesions can present with vague, nonspecific symptoms and may mimic malignancy or infections such as pancreatic tuberculosis (TB), especially on imaging. Pancreatic tail tuberculosis is an exceedingly rare phenomenon and is rarely reported. While MRI with contrast and diffusion-weighted imaging helps characterize these lesions, histopathology remains essential for definitive diagnosis. Case presentation: A 62-year-old female presented with vague, intermittent colicky pain around the umbilical area, accompanied by notable weight loss and a decrease in appetite. He also experienced a dry, intermittent cough lasting the same duration. There were no signs of fever, night sweats, jaundice, a history of tuberculosis, or contact with anyone who had a chronic cough. Physical examination revealed mild epigastric tenderness with no palpable masses. Laboratory investigations, including liver function tests and pancreatic enzymes, were within normal limits. An abdominal ultrasound and CT scan performed at the referring hospital both indicated a pancreatic mass. The institution, ultrasound-guided fine needle aspiration cytology (FNAC) of the pancreatic tail was conducted, which revealed findings consistent with tuberculosis. There were no other indications of malignancy. The patient was initiated on an anti-TB regimen and showed clinical improvement. She is currently on follow-up at the institution. Clinical discussion: Imaging findings raised suspicion for a malignant neoplasm such as pancreatic adenocarcinoma or neuroendocrine tumor. However, features like central necrosis and lymphadenopathy are also seen in pancreatic TB. Differentiation between malignancy and TB based solely on imaging is challenging, particularly in endemic regions. Histopathological analysis through biopsy is critical to confirm the diagnosis and avoid mismanagement, as TB is a treatable condition with medical therapy. Conclusion: This case highlights the importance of correlating clinical, radiologic, and pathological findings when evaluating pancreatic lesions. A tissue diagnosis is crucial for distinguishing between malignancy and uncommon infections such as pancreatic tail tuberculosis, which was performed in a patient. Following this diagnosis, the patient showed clinical improvement with anti-TB treatment during follow-up.