Diagnosis of major salivary gland tuberculosis: Experience of eight cases and review of the literature

Conclusions. Tuberculosis of the salivary gland is mostly a medically curable disease entity but early diagnosis is very important to ensure complete remission. In cases with a high index of suspicion, reliable diagnostic methods such as polymerase chain reaction (PCR) should always be considered before surgical intervention to enable differential diagnosis of a salivary gland tumor. Objectives. To investigate the clinical characteristics of major salivary gland tuberculosis and to review the literature relating to its diagnosis. Material and methods. Eight patients diagnosed as having major salivary gland tuberculosis between 1994 and 2004 were treated at one of three tertiary referral centers. Medical records, including imaging findings and the results of microbiological tests, Mycobacterium tuberculosis PCR and histopathology, were retrospectively retrieved and the literature was reviewed. Results. The parotid and submandibular glands were involved in 5 (62.5%) and 3 cases (37.5%), respectively. Neck CT demonstrated typical findings of salivary gland tuberculosis in 3 patients (37.5%). Fine-needle aspiration cytology revealed chronic inflammation in 6/7 patients (85.7%), 2 of whom (33.3%) showed caseous necrosis, strongly suggesting tuberculosis. Five of the 8 patients (62.5%) required resection of the affected gland and 3 (37.5%) received open biopsy. PCR was performed in half of the cases and was affirmative in every case. No significant differences were found between the surgically resected and non-resected groups in terms of treatment results or morbidity. All patients received anti-tuberculous chemotherapy for 8-12 months, with no disease recurrence.