Tuberculosis of the parotid gland: clinically indistinguishable from a neoplasm

Abstract

Tuberculosis of the parotid gland may be clinically indistinguishable from a neoplasm. This poses a problem with regard to management, because the treatment of tuberculosis is medical, whilst that of the majority of tumours is surgical. If radical surgery with resection of a branch or branches of the facial nerve is embarked upon in a patient with tuberculosis, without prior histological diagnosis, unnecessary permanent disability will result. Two cases of tuberculosis of the parotid gland are reported, demonstrating the clinical similarity of tuberculosis to a parotid neoplasm and the absolute need for histological diagnosis before embarking on surgery that will require resection of the branches of the facial nerve. The conclusion is that although tuberculosis of the parotid gland is rare, it still exists and must be thought of as one of the differential diagnoses of a parotid tumour. This must be kept in mind, especially when the decision to sacrifice branches of the facial nerve is indicated, in order to get a tumour-free margin on an excisional biopsy. If the suspicion of tuberculosis is high, a therapeutic trial of antituberculous chemotherapy, for one week, can be diagnostic.

Tuberculosis of the Parotid Gland

“…The clinical appearance may mimic parotitis or a parotid tumor. [1][2][3] The existence of a known parotid lesion, with or without enlarged cervical lymph nodes and with no history or other evidence of TB, was suggestive of a malignancy. Patients may therefore be referred for surgical intervention, which apparently carries risks of destruction of the parotid gland with fistula formation or facial palsy.…”

“…Patients may therefore be referred for surgical intervention, which apparently carries risks of destruction of the parotid gland with fistula formation or facial palsy. [3][4][5][6] In a review of 216 surgeries for parotid tumors, Suoglu et al 1 found 6 patients (2.8%) with parotid TB. If presurgical evaluation can exclude the possibility of a tumor, the condition can be managed properly with medical treatment.…”

“…We therefore recommend performing a sonographically guided FNA cytologic study for a poorly defined parotid nodule, although multiple passes or multiple aspirations can be required. 7 After reviewing 20 patients reported in 7 articles published between 1990 and 1998, [1][2][3][4][5][6][7] we found that FNA had been tried in 9 patients, and the results varied considerably. In the best results obtained by Weiner and Pahor, 7 mycobacterial infection of the parotid gland, of whom FNAs were done in 3.…”

Recurrent Parotitis: Extrapulmonary Manifestation of Childhood Tuberculosis

“…Surgical exploration could lead to permanent facial nerve damage, gland destruction, fistula formation [9] and was deferred due to the negative consent given by the parents.…”

Renewing Our Understanding of Tuberculosis as a Multi-Organ Disease

“…Isolation of M. tuberculosis from the biopsied parotid gland confirmed tuberculous parotitis. In MEDLINE,there are a considerable number of recent reports on tuberculous parotitis (2,3). These consecutive cases of myownrenewed the old knowledge, that tuberculosis truly is a multi-organ disease.…”