To our knowledge, the present cases are the first for which mycobacterial infection within Warthin's tumor was confirmed by PCR. Furthermore, the results indicate that the lymphoid stroma of such lesions can behave in the same manner as regional lymph nodes. CLINICAL SUMMARY Case 1A 75-year-old woman presented with a right neck mass, a decreased level of consciousness and associated pyrexia (38.0°C) in July 1990. Mental deterioration had progressed rapidly over the previous 5 days. The patient had a medical history of hypertension and diabetes mellitus. Laboratory tests were normal except for hyponatremia, an elevated serum glucose level, and a slight increase in blood urea nitrogen. Sodium infusion markedly improved her consciousness, although not back to the normal level.The right neck mass was surgically excised 1 month after admission. Pathological examination revealed Warthin's tumor and multiple epithelioid granulomas with caseous necrosis. Samples obtained at biopsy were not submitted for bacteriological investigation.Examination of cerebrospinal fluid revealed a white blood cell (WBC) count of 152/mL (with 91% lymphocytes), a raised protein concentration (525 mg/dL), a decreased glucose concentration (54 mg/dL) and a plasma glucose concentration of 200 mg/dL. A tryptophan test was positive. Cerebrospinal fluid was subjected to microscopy and culture but no organisms or acid-fast bacilli were apparent. No pulmonary lesions were found by chest X-ray. Based on these findings, tuberculous meningitis was suspected, and empirical treatment with the anti-tuberculosis drugs isoniazid and streptomycin was commenced. Although the patient's fever was lowered and her consciousness level restored temporarily, it worsened again and she died 4 months after diagnosis. An autopsy was not done.

Our data indicated that suction curettage plus endometrial cytology was the best combination for pathological examination of outpatients with abnormal uterine bleeding.

No abstract