An Unusual Reason Of Parotid Gland Enlargement: Parotid Gland Tuberculosis

摘要

Objective: Our aim was to better understand the rarely encountered tuberculous parotitis Methods: A case report Results: Parotid gland involvement of tuberculosis is extremely rare, even in endemic region of disease. However, it should be considered in the differential diagnosis of parotid gland mases. Imaging and fine needle aspiration cytology are often inconclusive , and thus most cases require removal of the salivary gland to enable a final diagnosis to be made as in this case. Once the diagnosis of tbc is made , standard antituberculosis treatment is given with an initial phase lasting 2 months and a further phase that lasts 4-6 months Conclusion: Clinicians should have a high index of suspicion for tuberculosis of the parotid gland in patients with a chronic parotid lump, even if the chest radiographs appear normal. Introduction The incidence of tuberculosis (tbc) is rising throughout the world. Pulmonary tbc is the most frequent form of tbc, but any organ in the body can be involved (1). Tumors of salivary gland origin are rare. Approximately 80% of tumors of salivary gland origin arise from the parotid gland , and, of these, 80% are benign. Approximately 60-90% of the benign parotid neoplasms are pleomorphic adenomas. Parotid gland tbc is an uncommon disease. Less than 200 cases have been reported since the first description of this condition. These cases include tbc of the intraparotid lymph nodes or primary tbc of the parotid gland substance (2). These intraparotid and periparotid lymph nodes may become infected either by lymphatic drainage from the oral cavity or hematogenously from a pulmonary focus. The diagnosis of parotid gland tbc can only be confirmed by gland excision. Although it is very rare, it should be kept in mind in the differential diagnosis of benign parotid lesions (1). A case of involvement of intraparotideal lymph nodes with tbc was presented in this article. Our purpose was to investigate the clinical and surgical characteristics of major salivary gland tbc. Case report A 37 year old female applied to our ENT clinic for the right parotid enlargement. The swelling became larger with time. She had been given several courses of antibiotic treatment for several months with no improvement in her condition. She denied any symptoms of weighing loss, cough, fever, chest pain and night swelling. She did not give any past history of tbc infection either in herself or in her family. Examination revealed 4x4 cm painless, rubber like lesion in the right parotid gland and 2x1 cm lymph nodes in the upper servical region. There was no sign of fistula or color change on the overlying skin.Laboratory profile was unremarkable including PPD test, which was done after the pathological investigation. Chest X-ray was normal. Multiple lymph nodes, the largest one was 13x10 mm, were detected in the right parotid gland and multiple lymph nodes, the largest one was 34x22 mm, in the right upper servical region in USG investigation. The spiral CT scan showed 2x2.5 cm, contrast enhanced peripheral borders, central cystic-necrotic, regular contoured, bilobulated lesion in the right parotid gland (Figure 1). Superior to this lesion there was a 8 mm intraparanchimal lymph node. In the upper servical region, there were multiple lymph nodes with the same scan findings in the parotid gland. These findings were reported as consisted with pleomorphic adenoma or adeno carcinoma. Fine neddle aspirations performed three times showed lymphocytes and germinal center cells and patchy eosinophils. With all these findings, thinking the benign nature of the lesion, parotidectomy was planned for this case. During surgery, the mass was within the parotid gland and very adhesive to surrounding and it was extending to deep lobe. Subtotal parotidectomy with preservation of facial nerve was performed. The frosen section investigation showed granulomatous inflammatory reaction. There were multiple conglomerated, 2x3 cm lymph nodes in the right upper