Wang Shu-yi, Zhu Jia-xing
Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China. E-mail:
Department of Pathology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai 200031, China.
Zhonghua Bing Li Xue Za Zhi. 2013 Oct;42(10):683-6.
To study the clinicopathologic features, histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region.
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.
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.
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.
研究头颈部原发性黏膜结核（TB）的临床病理特征、组织学诊断及鉴别诊断。
采用苏木精-伊红染色和齐-尼氏染色对47例头颈部原发性黏膜结核病例进行研究。结合文献分析其临床和病理特征。
患者中男性26例，女性21例，平均年龄47.1岁（范围14 - 84岁）。其中鼻窦结核3例，鼻咽结核19例，口咽结核2例，喉结核18例，中耳结核4例，涎腺结核1例，1例喉结核合并喉癌。首发症状包括鼻塞、黏液脓性鼻漏、鼻出血、打鼾、声音嘶哑、吞咽困难、吞咽痛、浆液性中耳炎、听力减退、耳鸣和耳痛。体格检查结果各异，从黏膜外观基本正常到有明显肿物，或黏膜呈腺病样或肿胀外观、溃疡、白斑区以及它们的各种组合。CT和MRI表现包括弥漫性增厚、软组织肿物、肿物内钙化以及类似恶性肿瘤的骨质破坏。组织学检查显示肉芽肿，中央有坏死灶，周围为上皮样组织细胞和多核朗汉斯巨细胞。抗酸杆菌难以显示，但在45例中有13例发现。42例患者有随访资料。
头颈部黏膜原发性结核罕见。它可能与其他疾病相似或并存。其特征性组织病理学表现为中央干酪样坏死的肉芽肿和朗汉斯巨细胞。抗酸杆菌的鉴定及细菌学培养可确诊分枝杆菌病。
