Primary parotid tuberculosis mimicking parotid neoplasm: a case report

Abstract

Introduction: Tuberculosis of the parotid gland is a rare clinical entity which causes some difficulties in diagnosis because of the similarities in presentation to that of a neoplasm. Diagnosis mainly relies in the treating physician having a high index of suspicion. The diagnosis is generally overlooked by otolaryngologists and most cases are undergoing unnecessary surgery.

Case presentation: A 20-year-old male presented with a mass in the right parotid region. The mass had been present for one year. Physical examination revealed a mobile, non-tender mass occupying the superficial lobe of the right parotid gland. Radiologic investigations revealed a well-defined, solid, mass lesion located in the posterior part of the superficial lobe of the right parotid gland. A provisional diagnosis of a neoplasm of the parotid gland was made and a right superficial parotidectomy was performed. Histopathologic examination of the specimen was reported as tuberculosis of the parotid gland. The patient was commenced on antitubercular chemotherapy.

Conclusion: Although rare, tuberculosis should be kept in mind and considered in the differential diagnosis of patients presenting with a solitary tumor in the parotid gland in order to avoid unnecessary surgery.

Figure 1

An axial fat saturated T2-weighted image through the parotid gland demonstrates a well-defined high signal intensity mass in the superficial area of the right parotid gland.

Figure 2

(a) Granulomatous inflammation in a lymph node abutting the parotid gland (H&E ×50), (b) Langhans type giant cells in granulomatous inflammation (H&E ×200).