Tuberculous parotitis: A series of eight cases and review of literature

Abstract

Although tuberculosis is a common health problem in developing countries such as India, tuberculous parotitis (tubercular involvement of parotid gland) is rarely encountered. Because of very low incidence and nonspecific symptoms, it is often misdiagnosed as parotid neoplasm. Ultrasonographic and computed tomographic findings are also noncontributory for this entity. Hence, to increase awareness about this rare entity, here, we report a series of eight cases of tuberculous parotitis which were diagnosed on fine-needle aspiration cytology (FNAC) and successfully treated with antitubercular drugs. Majority of our cases (five cases) presented as asymptomatic unilateral swelling or acute tender painful swelling (two cases) in the parotid region. FNAC smears showed caseous necrosis, epithelioid granulomas along with variable amount of mixed inflammatory exudates, and few benign ductal or acinar cell clusters. One case had unilateral recurrent swelling in the preauricular region with fistula. Superficial parotidectomy was done and histological examination revealed the diagnosis of tubercular parotitis. Following diagnosis, all patients were kept on antitubercular treatment and responded well to treatment with no evidence of recurrence on 9-month regular follow-up.

Keywords: Parotid; salivary gland; tubercular.

Figure 1

Tender and soft swelling in the left preauricular region (a). Nontender and firm swelling in the left preauricular region (b)

Figure 2

Diffuse and firm swelling in the right preauricular region (a). Computed tomography scan of the same patient showing soft-tissue attenuation in the deep lobe of the right parotid gland (b)

Figure 3

Epithelioid granuloma in the background of caseous necrosis and inflammatory cells (H and E, ×100) (a). Granuloma in high-power view (H and E × 400) (b)

Figure 4

Excised specimen with fistulous tract (arrow) and surrounding skin (a). Gross specimen: Cut surface of parotid gland showing gray-white gland parenchyma with foci of necrosis (arrow) (b)

Figure 5

Histopathology: Multiple epithelioid granuloma in parotid gland parenchyma (H and E, ×40) (a). (H and E, ×100) (b). (H and E, ×400) (c). Periductal granuloma (H and E, ×200) (d). Periglandular lymphoid tissue involvement by granuloma (H and E, ×200) (e). Periglandular fibrous tissue showing granuloma with Langhans giant cell (H and E, ×400) (f). (granuloma shown by arrow)