Clinicopathological analysis of nasopharyngeal tuberculosis

Abstract

Background: The aim of this study is to examine the clinical and pathological attributes of nasopharyngeal tuberculosis.

Methods: We conducted a retrospective analysis of the clinicopathologic characteristics of nasopharyngeal tuberculosis in 14 patients. The medical records and imaging data obtained between March 2004 and February 2023 were scrutinized. During the pathological review, we classified the types of granulomatous inflammation and graded the extent of caseation.

Results: Results indicate a 100% female predominance, with chief complaints including hearing loss, postnasal drip, and nasal obstruction. Cervical lymphadenopathy occurred in 21.4% of patients. Chest radiograph abnormalities were found in 58.3%, with three showing active pulmonary tuberculosis. Endoscopic examination revealed three types of lesions, and CT/MRI findings correlated with gross lesions. A statistically significant association was found between lesion characteristics (bulging, ulcerative, necrotic) and pathology patterns (sarcoidosis-like, caseation). Bulging masses exhibited sarcoidosis-like patterns, while ulcerative/necrotic lesions were often associated with caseation. All lesions responded well to over six months of anti-tuberculosis medication, leading to favourable outcomes.

Conclusion: We studied 14 cases of nasopharyngeal tuberculosis, mostly in females, with common ear and nose symptoms. Lesions were typically visible on nasopharyngeal endoscopy, and endoscopically bulging mass-like lesions had pathologically sarcoidosis-like granulomas. All patients had favourable outcomes.

Keywords: Nasopharynx; endoscopy; granuloma; tuberculosis.

Figure 1.

The pathological types of nasopharyngeal tuberculosis. The pathological types were classified into three groups according to the dominant pathological pattern. (A) sarcoidosis-like pattern, (B) caseous pattern and (C) non-specific inflammatory pattern (x4, x100 objective, HE stain).

Figure 2.

Endoscopic findings of nasopharyngeal tuberculosis. Endoscopic imagings showing (A) bulging mass-like lesion (B) ulcerative lesion with minimal necrosis, and (C) necrotic, whitish color lesion that infiltrates the Eustachian tube. (D–F) Resolved lesions after anti-tuberculosis medication. Endoscopic images (before treatment) (A–C) correspond to (D–F) (after treatment), respectively.

Figure 3.

Imagings of nasopharyngeal tuberculosis. Head and neck CT showing (A) bulging mass lesion in the posterior nasopharynx wall (B) no mass lesion on the nasopharynx wall but diffuse wall thickening with enhancement along the nasopharyngeal wall and left Eustachian tube. T1 gadolinium-enhanced MRI imaging shows (C) homogenous mass confined to the nasopharynx (D) no mass lesion on the nasopharynx but enhancement along the left Eustachian tube.