Other abbreviations. Ref: reference. (DOCX) Click here for additional data file.(168K, docx) Funding Statement Gemcitabine mechanism The University of Cologne provided the fulltexts. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
A 29-year-old man presented with burning epigastric pain, raised temperature, night sweats, and headaches. There was no cough and chest radiograph was normal (Figure 1). Laboratory findings included alanine aminotransferase 70 U/L (normal, <50), alkaline phosphatase 160 U/L (<130), lipase 188 U/L (<51), LDH 376 U/L (<250), CRP 110 mg/L (<10). To exclude pancreatitis or cholecystitis, ultrasonography of the abdomen was performed, which revealed a non-vascular, 3,8 �� 1,8 cm mass with cystic and solid components in the epigastrium next to the portal vein (Figure 2).

Differentiation between a pancreatic lesion or an adjacent or infiltrating lesion from the porta hepatis was not possible because of its peripheral localization relating to the pancreatic head. Computed tomography (CT) showed a multi-cystic, partially solid mass with slight contrast enhancement in the area of the pancreas head, located in the branching of the celiac trunk and adjacent to the portal vein (Figure 3). No intra- or extrahepatic dilatation of the bile ducts, and no obstruction or thrombosis of blood vessels was seen. The etiology of the lesion remained unclear. Magnetic resonance cholangiopancreaticography (MRCP) was performed and confirmed the CT findings and showed clear contrast enhancement of the lesion (Figure 4 to to6),6), displacement of the pancreatic duct but no obstruction or ductal dilatation.

Slightly enlarged lymph nodes at the porta hepatis and in the interaortocaval area were identified. A pancreatic pseudocyst seemed unlikely given the absence of findings suggestive of previous pancreatitis in all images. A pancreatic cystadenoma or a solid pseudopapillary tumor seemed unlikely given the raised temperature and elevated CRP. Figure 1 29-year-old male with isolated pancreatic tuberculosis. Normal posterior-anterior chest radiograph with absence of tuberculosis related findings. Figure 2 29-year-old male with isolated pancreatic tuberculosis. Ultrasonography was performed using a 3,5MHz convex transducer; color-Doppler image shows no perfusion of a well defined 3,8 �� 1,8 cm mass (arrows) with cystic and solid components.

Figure 3 29-year-old male with isolated pancreatic tuberculosis. Axial computed tomography – unenhanced (a�Cb) and enhanced images (c�Cd arterial phase and e�Cf portal phase), obtained by a multidetector Brefeldin_A scanner (Protocol: 120 Kv, with a max. … Figure 4 A 29-year-old male with isolated pancreatic tuberculosis. Axial T2 weighted MR image (a) and Volume Interpolated Gradient Echo MR images after contrast administration during the arterial (b), portal (c) and the equilibrium phase (d) show a well defined …