title: [Primary mucosal tuberculosis of head and neck region: a clinicopathologic analysis of 47 cases].
abstract: OBJECTIVE
  To study the clinicopathologic features, histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region.
  
  
  METHODS
  Forty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains. The clinical and pathologic features were analyzed with review of the literature.
  
  
  RESULTS
  The patients included 26 male and 21 female, with mean age 47.1 years (range 14-84 years). There were three sinonasal TB, 19 nasopharyngeal TB, two oropharyngeal TB, 18 laryngeal TB, four middle ear TB, one salivary gland TB and one laryngeal TB complicating laryngeal cancer. The initial symptoms were nasal obstruction, mucopurulent rhinorrhea, epistaxis, snoring, hoarseness, dysphagia, odynophagia, serous otitis, hearing loss, tinnitus, and otalgia. Physical examination result was variable, from an apparently normal mucosa, to an evident mass, or a mucosa with an adenotic or swollen appearance, ulcers, leukoplakic areas, and various combinations thereof. CT and MRI findings included diffuse thickening, a soft-tissue mass, calcification within the mass and bone destruction resembling malignancy. Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells. Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases. Follow-up data were available in 42 patients.
  
  
  CONCLUSIONS
  Primary TB arising in the head and neck mucosa is rare. It may mimic or co-exist with other conditions. The characteristic histopathology is a granuloma with central caseous necrosis and Langhans'giant cells. Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.
authors.affiliation: Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China. E-mail: wangshuyi@eent.shmu.edu.cn.
authors.forename: Shu-yi
authors.initials: SY
authors.lastname: Wang
authors.affiliation: Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China.
authors.forename: Jia-xing
authors.initials: JX
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000382:microbiology / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007822:Laryngeal Neoplasms / Q000150:complications / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010038:Otorhinolaryngologic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology* / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D014374:Tuberculin Test; D014376:Tuberculosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D014387:Tuberculosis, Laryngeal / Q000150:complications / Q000601:surgery; D014393:Tuberculosis, Oral / Q000188:drug therapy / Q000473:pathology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents