Endoscopic ultrasonography-guided fine-needle aspiration for the diagnosis of retroperitoneal tuberculosis: A case report

Abstract

Retroperitoneal tuberculosis is a rare disease that can mimic many conditions and lacks specific clinical manifestations, which makes it difficult to diagnose. As a consequence, it can be misdiagnosed as a malignant tumour. Endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) can obtain specimens of the lesion site from areas that might be inaccessible using more traditional biopsy methods. A 60-year-old female patient was admitted with a 3-month history of intermittent upper abdominal pain accompanied by nausea. Imaging found pancreatic uncinate process and retroperitoneal lymph nodes at the horizontal part of the duodenum. EUS-FNA found necrotic matter, multinucleated giant cells and epithelioid cells consistent with the signs of tuberculosis bacilli infection, although typical noncaseous granuloma and Mycobacterium tuberculosis were not observed. Retroperitoneal tuberculosis was considered as the diagnosis. After anti-tubercular therapy, the signs and symptoms quickly improved and a repeat computed tomography scan found that the space-occupying lesion had reduced in size. By using EUS-FNA, the cytological and histopathological findings can be obtained in a timely manner to facilitate an earlier diagnosis and avoid unnecessary procedures such as laparotomy or surgery.