Clinical Analysis for Diagnosis and Treatment of Major Salivary Gland Tuberculosis / 대한이비인후과학회지

ABSTRACT

BACKGROUND AND OBJECTIVES: Tuberculosis of salivary gland is a rare disease but it must be considered in the context of the patient presenting the salivary gland mass. The purpose of this study is to investigate the clinical characteristics of a major salivary gland tuberculosis by determining the diagnostic usefulness of the radiographic, histopathologic, microbiological and molecular biologic evaluations. SUBJECTS AND METHOD: Eight patients diagnosed as having major salivary gland tuberculosis between June 1998 and June 2004 were treated at three tertiary referral centers. Medical records, including imaging, microbiological tests, M. tuberculosis polymerase chain reaction (PCR), and histopathology results were retrieved retrospectively and the literature was reviewed. RESULTS: Parotid glands and submandibular glands were involved in five (62.5%) and three (37.5%) cases, respectively. Neck CT demonstrated typical findings of salivary gland tuberculosis in three patients (37.5%). Fine needle aspiration cytology (FNAC) revealed chronic inflammation in six of seven patients (85.7%), two of which showed caseous necrosis, strongly suggesting tuberculosis (2/6, 33.3%). Five of the eight patients (62.5%) required resection of the affected gland and three (37.5%) received open biopsy. PCR was performed in half of the cases, all of which were affirmative. No significant difference was found between surgically resected and non-resected groups in terms of treatment results or morbidity. All patients received anti-tuberculous chemotherapy for 8 to 12 months with no disease recurrence. CONCLUSION: Tuberculosis of the salivary gland is mostly a medically curable disease entity. In cases with high index of suspicion, FNAC coupled with PCR may become an effective and alternative diagnostic tool for salivary gland tuberculosis. This diagnostic approach should be considered before surgical intervention for the differential diagnosis of salivary gland tumor.