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World J Clin Cases. Apr 6, 2023; 11(10): 2181-2188
Published online Apr 6, 2023. doi: 10.12998/wjcc.v11.i10.2181
Cheesy material on macroscopic on-site evaluation after endoscopic ultrasound-guided fine-needle biopsy: Don't miss the tuberculosis
Hanane Delsa, Khadija Bellahammou, Hussein Hassan Okasha, Fahd Ghalim
Hanane Delsa, Fahd Ghalim, Department of Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca 82403, Morocco
Khadija Bellahammou, Department of Oncology, Tetouan Hospital, Tetouan 93000, Morocco
Hussein Hassan Okasha, Department of Internal Medicine, Division of Gastroenterology, Hepatology and Endoscopy, Kasr Al-Ainy School of Medicine, Cairo university, Cairo 11562, Egypt
Author contributions: Delsa H collected the literature; Delsa H and Bellahammou K wrote the manuscript, and Okasha HH and Ghalim F revised the paper; All authors read and validated the final version of the manuscript.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hanane Delsa, MD, Assistant Professor, Department of Gastroenterology and Hepatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Avenue Mohamed Taieb Naciri, Casablanca 82403, Morocco. dr.delsa.hanane@gmail.com
Received: December 27, 2022
Peer-review started: December 27, 2022
First decision: January 22, 2023
Revised: January 28, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: April 6, 2023
Processing time: 92 Days and 20.6 Hours
Abstract

Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) is an excellent investigation to diagnose pancreatic lesions and has shown high accuracy for its use in pathologic diagnosis. Recently, macroscopic on-site evaluation (MOSE) performed by an endoscopist was introduced as an alternative to rapid on-site cytologic evaluation to increase the diagnostic yield of EUS-FNB. The MOSE of the biopsy can estimate the adequacy of the sample directly by the macroscopic evaluation of the core tissue obtained from EUS-FNB. Isolated pancreatic tuberculosis is extremely rare and difficult to diagnose because of its non-specific signs and symptoms. Therefore, this challenging diagnosis is based on endoscopy, imaging, and the bacteriological and histological examination of tissue biopsies. This uncommon presentation of tuberculosis can be revealed as pancreatic mass mimicking cancer. EUS-FNB can be very useful in providing a valuable histopathological diagnosis. A calcified lesion with a cheesy core in MOSE must be suggestive of tuberculosis, leading to the request of the GeneXpert, which can detect Mycobacterium tuberculosis deoxyribonucleic acid and resistance to rifampicin. A decent diagnostic strategy is crucial to prevent unnecessary surgical resection and to supply conservative management with antitubercular therapy.

Keywords: Pancreatic tuberculosis; Endoscopic ultrasound; Fine-needle biopsy; Macroscopic on-site evaluation; Cheesy material; GeneXpert

Core Tip: In this article, we discussed the role of endoscopic ultrasound with fine-needle biopsy as a diagnostic tool in patients with suspicious pancreatic tuberculosis. This review aims to provide knowledge on the utility of fine-needle biopsy and macroscopic on-site evaluation of the core to suspect pancreatic tuberculosis, in addition to diverting the attention of the endoscopists to consider tuberculosis when the core is cheesy.