Читать книгу Salivary Gland Pathology - Группа авторов - Страница 129

Tuberculosis is a chronic infectious disease with worldwide distribution, although more commonly seen in developing countries. While primarily noted in the lungs and characterized by caseous necrosis, extrapulmonary forms of the disease account for approximately 20% of active tuberculosis and can affect any organ in the body (Maurya et al. 2019). The most common head and neck manifestation of mycobacterium tuberculosis is infection of the cervical lymph nodes. Tuberculous infection of the salivary glands is very rare and generally seen in older children and adults. Parotid tuberculous constitutes 2.5–10% of salivary gland tuberculosis (Maurya et al. 2019). Salivary glands are thought to resist the growth of mycobacterium tuberculosis due to the continuous flow of saliva that prevents colonization of the bacteria. The infection is believed to originate in the tonsils or gingiva and most commonly ascends to the parotid gland via its duct (Arrieta and McCaffrey 2005). Secondary infection of the salivary glands occurs by way of the lymphatic or hematogenous spread from the lungs. Clinically, tuberculous salivary gland infection presents in two different forms. The first is an acute inflammatory lesion with diffuse glandular edema that may be confused with an acute sialadenitis or abscess. The chronic lesion occurs as a slow‐growing painless mass with or without cervical adenopathy that mimics a tumor. Patients with tuberculous parotitis have been further classified into three groups: group 1 – patients with asymptomatic unilateral preauricular swelling; group 2 – patients with recurrent swelling with fistula; and group 3 – acute inflammatory swelling/abscess. Diagnosis by fine needle aspiration biopsy may elude surgeons and cytologists such that surgery may be required for definitive diagnosis. If the diagnosis is established by nonsurgical means, treatment of the tuberculous sialadenitis is accomplished with medical therapy against the tuberculous infection.

Figure 3.16. A 21‐year‐old woman (a) with a two‐week history of left submandibular pain and swelling. A history of animal scratch was provided. Computerized tomograms (b) revealed a mass of the left submandibular gland. The patient was taken to the operating room where excision of the submandibular gland and mass was performed. Wide access was afforded (c) and the mass was exposed (d). The specimen is noted in (e). Histopathology showed a stellate abscess (f). A Steiner stain (g) showed Bartonella (Gram negative bacillus). Her disease resolved without long‐term antibiotics as seen in five‐year postoperative images (h and i).