Mediastinal lymphadenopathy in ampullary adenocarcinoma: not always metastatic

Authors Chalapathi A.S. Rao, Surinder S. Rana, Deepak K. Bhasin, Ritambhra Nada, Santosh Sampath, Bhagwant R. Mittal, Vishal Sharma, Harpal S. Dhaliwal, Kartar Singh.


Malignancies can metastasize through hematogenous or lymphatic routes. Enlarged lymph nodes in a known case of malignancy do not always imply metastasis. A middle-aged female patient presented to us with abdominal pain and jaundice. Investigation revealed ampullary growth due to adenocarcinoma. Positron emission tomography-computerized tomography scan revealed uptake of the tracer in the ampullary region as well as in enlarged mediastinal lymph nodes. Endoscopic ultrasound-guided fine needle aspiration cytology of the mediastinal lymphadenopathy revealed it to be tuberculous. Mere radiologic evidence of a distant nodal spread must not be regarded as final evidence and obtaining a tissue diagnosis should be strongly considered, as potentially curative therapy may be offered.

Keywords endoscopic ultrasound, tuberculosis, adenocarcinoma, pancreas, lymph node
Ann Gastroenterol 2012; 25 (2): 167-169

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