[Tuberculosis of the parotid gland: a rare differential diagnosis of parotid tumor]

A Franzen, C K Franzen, K Koegel
Laryngo- Rhino- Otologie 1997, 76 (5): 308-11

BACKGROUND: Mycobacterial infection of the parotid gland is rare even in countries where the disease is rife. Because patients do not have specific symptoms of tuberculosis and tuberculosis of the parotid gland frequently presents as a neoplasm, most patients undergo parotidectomy.

PATIENTS: In this text we present a case report and the review of 20 well documented cases from the literature. The problems of diagnosis and therapy, especially the problem of distinguishing tuberculous infection from another parotid swelling such as a benignoma or a granuloma, are analyzed.

RESULTS: Eighty percent of the patients we reviewed in our investigation originated from Asian or African countries. In most cases the history of the parotid swelling was shorter than one year, often even shorter than six months. In 17 of the 20 patients tuberculosis presented as a solid mass corresponding to the infection of a parotid lymph node. In three cases a diffuse infection of the whole gland was described. It was frequently impossible to distinguish tuberculosis from swelling of the parotid gland due to other causes by clinical or sonographical investigations. History of tuberculosis was given in two cases: the patients underwent an antituberculous therapy one and five years ago. The chest radiograph was normal in all but one cases. In two cases pretherapeutic diagnosis was made by biopsy, in two cases by fine needle aspiration cytology, which was performed in a total of seven cases.

CONCLUSION: Tuberculosis is a rare cause for parotid swelling. Nationality of the patient and a short history of the swelling may suggest a mycobacterial infection. Diagnosis by fine needle aspiration cytology may be difficult. Other investigations should be added, if necessary. Antituberculous therapy has to be done also in cases of organ tuberculosis after surgery. If the right diagnosis is known before therapy, parotictomy can be avoided.

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