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TUBERCULOMA OF POSTERIOR PHARYNGEAL WALL
RV Juvekar*, MR Juvekar**, DV Panchal**
*Professor; Registrar in Dept. of Otorhinolaryngology, LTNI Medical College and Hospital, Mumbai - 400 022.
A 28 year old male presented with a rare case of primary tuberculosis oforopharynx whose site and appearance simulated a malignancy, but histopathology showed a tuberculoma .INTRODUCTION
Lecointre et al from France in 1980 reported 37 cases presenting with tuberculous lesion in the nasopharynx, of these 34 were from European communities, and 3 were North African. 56% patients had palpable lymphadenopathy. All these patients were confirmed with histology and treated medically with satisfactory results.
Haacke et al in 1984 have documented a case of tuberculoid granuloma of pharynx in a 38 year old Nigerian woman. Meuthen et al in 1993 reported a case of 65 year old female with an 11 year old history of a slowly progressive tumour, which stimulated a malignancy, but histopathology was tuberculous in actiology.
CASE REPORT
A 28 year old male presented with a painful swelling in the throat since one month. He had a progressive dysphagia to both solids and liquids. There was no history of fever, cough, oral bleed or breathlessness. Patient had no past history of tuberculosis in self or family. He had undergone a drainage of a retropharyngeal abscess one month back, the aetiology of which was not known.
On examination patient was afebrile, averagely built. His vital parameters were normal. Oral cavity showed a non tender, firm mass on the posterior pharyngeal wall of 3 cm x 3 cm in size at the level of soft palate extending downwards. The surface of the mass was ulcerated at places and covered with granulations. The mass bled minimally on touch. Except for bilateral, non tender, mobile, jugulodigastric lymph nodes, there was no other lymphadenopathy. The mass was extending upto the level of epiglottis. The larynx was normal on indirect laryngoscopy,
Hb 14 gnily,, WBC I 1000/cm,
Polymorphs 75. Lymphocytes 20. Eosiuophils 5,
ESR - 110 mm. at I 11F.
HIV and VDRL tests were negative.
No acid-fast bacilli were detected in the sputum. X-ray chest was clear. Orthopaedic and Radiological opinion was taken for X-ray cervical spine which did not show any abnormality suggestive Of tuberculosis of spine. The punch biopsy showed no evidence Of malignancy, but on!% chronic inflammatory tissue.
TREATMENT
Excision of the mass was done under general anaesthesia. Histology showed giant cells, caseation, lymphocytcs and eptheliod cells, thus features suggestive of tuberculous aetiology
Patient was started on 4 drug Anti-tuberculous therapy for 9 months and has recovered completly. Wound on posterior pharyn.-cal wall has completely healed. There is no evidence of tuberculosis anywhere else in the body.
DISCUSSION
Primary presentation of tuberculosis of posterior pharyngeal wall is uncommon It may present as an ulceration, granuloma or a lupoid lesion. Common being the ulceration variety. Primary tuberculosis of tonsil is a well recognize entity even though oral manifestation of tuberculosis is usually secondary to pulmonary lesions. Here we have presented a rare case of primary tuberculosis of posterior pharyngeal wall.
The tuberculoma closely resembles a neoplasm by forming a large ulcerated mass and is usually associated with localised enlargements of glands of neck which was not seen in this case.
Primary tuberculosis of oral cavity is rare, because the upper respiratory tract is resistant to tuberculous infection. Saliva along with saprophytes and the protective epithelial covering in the oral cavity inhibit the tubercle bacilli.
Differential diagnosis apart from malignancy include midline granuloma, Wegener's granulomatosis, syphilis, nonspecific granuloma in HIV positive patients.
REFERENCES
1. Hall, Colman. TB of the pharynx. Diseases of Nose, Throat and Ear. 176-77.
2. Haacke N, Stafford N. Tuberculoid granuloma of the pharynx. Journal of Laryngology and Otology 1984; 99 : 32526.
3. Lecointre F, Marandas P, Michean C, Lacomde H, Schwaab B. La tuberculose des muqueuses des. VADS Etude clinique a propos de 37 cas suivis a IIGR (Tuberculosis of the mucosa of nasopharynx. A clinical study of 37 cases seen at Gustave - Roussy Institute between 1961 and 1978 (French). Annales d. Oto-Larynagologis et de Chirurgie Cervico-Faciale. 1980; 97 (6) : 423-33.
4. Meuthem, Hummefich, Kunstmann, Brusis, Spruth. Pharynktuberkulose ab Differential diagnose Zun Karzinom (Pharyngeal tuberculosis as differential diagnosis to carcinoma). ~German). HNO 1993~ 41 (11) :37-40.
5. Selimoglu, Stubeyas, Cifteioglu, Parlak, Esrefoglu, Ozturk. Primary Tonsillar tuberculosis : a case report. The Journal of Laryngology and Otology 1995; 109: 880-82.
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