Touihmi Safaa, Rkain Ilham
Department of Otorhinolaryngology -Head and neck surgery, University Hospital of Tangier-Tetouan-Al Hoceima, Morocco.
Abdelmalek Essaadi University of medicine and pharmacy, Tangier, Morocco.
Ann Med Surg (Lond). 2022 Mar 14;76:103436. doi: 10.1016/j.amsu.2022.103436. eCollection 2022 Apr.
Tuberculosis is a chronic bacterial infection caused by the . Extrapulmonary tuberculosis (EPTB) accounts for about 20% of cases in immunocompetent patients and 50% of cases in HIV-positive individuals (7). Except for the cervical lymph nodes location, head and neck tuberculosis is rare.
A 32-year-old man presented with chronic and progressive sore throat and dysphagia lasting for 4 months. The clinical examination revealed a lesion in the left piriform sinus confirmed by CT. a biopsy was performed and the histological results showed a chronic and granulomatous inflammatory process composed of epithelioid and giganto-cellular follicles centered by large areas of caseous necrosis, concluding tuberculosis of the pyriform sinus.
Primary tuberculosis of the hypopharynx is very rare. In most cases, is revealed by odynophagia, dysphagia, but it can also mimic the signs of a malignant tumor, hence, the difficulty in diagnosing this localization. Few articles have been reporting cases of hypopharyngeal tuberculosis, in these articles, the main symptom was dysphagia, as was the case with our patient. Given the rarity of hypopharyngeal tuberculosis, several differential diagnoses are to consider: squamous cell carcinoma, which is has a similar clinical manifestation to tuberculosis. There is also, rarely, oropharyngeal lymphoma, minor salivary gland tumors, neurogenic tumors, and Wegener's disease. The Diagnosis of EPT is established when bacillus is isolated and the epithelioid and giganto-cellular follicles centered by large areas of caseous necrosis is found in the histopathological examination of the endoscopic biopsy specimen. The Treatment is medical, by Anti bacillar chemotherapy, however the period is longer the pulmonary tuberculosis, it extends from of six to twelve months.Through this study, the main lesseons and are that Malignant lesion is always to rule out when a suspicious lesion of the hypopharynx is found, we also come to conclude that the ndoscopic and clinical aspect between tumoral and tuberculosis of the hypopharynx are very similar The diagnosis is confirmed with biopsy of the lesion.
primary tuberculosis of the pyriform sinus is very rare. it's mandatory to rule out malignant pharyngeal lesions and consider hypo-pharyngeal tuberculosis as one of the differential diagnoses in lesions especially in the countries where tuberculosis is endemic.
结核病是由……引起的一种慢性细菌感染。肺外结核病（EPTB）在免疫功能正常的患者中约占病例的20%，在HIV阳性个体中占病例的50%（7）。除了颈部淋巴结部位外，头颈部结核较为罕见。
一名32岁男性，出现持续4个月的慢性进行性咽痛和吞咽困难。临床检查发现左侧梨状窦有病变，CT予以证实。进行了活检，组织学结果显示为慢性肉芽肿性炎症过程，由上皮样和巨细胞滤泡组成，以大片干酪样坏死为中心，诊断为梨状窦结核。
下咽原发性结核非常罕见。在大多数情况下，表现为吞咽痛、吞咽困难，但也可能类似恶性肿瘤的体征，因此，该部位的诊断存在困难。很少有文章报道下咽结核病例，在这些文章中，主要症状是吞咽困难，我们的患者也是如此。鉴于下咽结核的罕见性，需要考虑几种鉴别诊断：鳞状细胞癌，其临床表现与结核相似。此外，很少见的有口咽淋巴瘤、小唾液腺肿瘤、神经源性肿瘤和韦格纳肉芽肿病。当分离出杆菌且在内镜活检标本的组织病理学检查中发现以大片干酪样坏死为中心的上皮样和巨细胞滤泡时，可确立EPT的诊断。治疗采用抗结核化疗，但疗程比肺结核长，从6个月到12个月不等。通过这项研究，主要经验教训是，当发现下咽可疑病变时，始终要排除恶性病变，我们还得出结论，下咽肿瘤和结核的内镜及临床表现非常相似，通过病变活检确诊。
梨状窦原发性结核非常罕见。必须排除咽部恶性病变，并将下咽结核作为病变的鉴别诊断之一，尤其是在结核病流行的国家。
