Primary Gastric Tuberculosis Mimicking Gastric Tumor That Results in Pyloric Stenosis

Summary BACKGROUND: Primary gastric tuberculosis is rarely seen. It usually produces a diagnostic challenge and may mimic peptic ulcer disease and even a neoplasia. We present a case of primary gastric tuberculosis initially thought to be a neoplasia. METHODS: A 46-year-old female was admitted with one-month history of nausea, vomiting and weight loss. A barium swallow showed a constant filling defect in the antral and prepyloric region. On upper endoscopy, an 8 cm mass was noted in antral and prepyloric regions. The biopsy specimens taken during endoscopy were insufficient for precise diagnosis. An operative diagnosis of gastric carcinoma leading to pyloric stenosis without any distant metastasis was made; a subtotal distal gastrectomy and roux-en-Y gastroenterostomy procedure was therefore applied. RESULTS: Pathologic evaluation revealed necrotic granulomatous inflammation throughout the wall of corpus, necrotizing granulomatous lymphadenitis in the lesser and greater curvature lymph nodes, and also in omentum. There were no findings of carcinoma. Ehrlich-Ziehl-Nielsen staining method revealed numerous acid-fast bacilli. Despite extensive studies, no evidence of extragastric tuberculous involvement was discovered, and she was prescribed an antituberculosis therapy for a period of one year. The patient remains asymptomatic. CONCLUSIONS: Primary gastric tuberculosis usually produces a diagnostic challenge and may mimic peptic ulcer disease and even a neoplasia.