14 Bombay Hospital Journal, Special Issue, 2009 Primary Tuberculosis of Parotid Gland Mimicking Parotid Tumour GD Bakhshi*, Aftab S Shaikh**, Ashok D Borisa**, Nilofar M Jamadar+, Abhishek G Singh***, Sameer H Vora*** Abstract Primary tuberculosis of parotid gland is rare. Its occurrence may pose a diagnostic problem in differentiating it from parotid tumours. It occurs without any primary focus in lungs or any pulmonary symptom. We report a case of 17 year old female who presented with clinical picture of parotid tumour. Ultrasound showed picture of nodule in parotid. Fine needle aspiration cytology (FNAC) was inconclusive. Superficial parotidectomy was done. Histopathology revealed tuberculosis of parotid gland. Four drugs Antikoch’s treatment (AKT) was given for two months and followed by two drugs for four months. Follow up of 6 months has shown patient to be symptom and disease free. *Asso. Prof., **Lecturer, ***Resident, Department of Surgery and +Chief Resident, Department of Radiology+, Grant Medical College and Sir J.J.Group of Hospitals, Mumbai - 400 008. Introduction T uberculosis in the parotid gland is an infectious disease. It manifests itself by an increase in gland volume; mainly involving glandular lymph nodes, making it lobulated and causing lymphadenitis. Primary tuberculosis of parotid gland is rare even in countries like India where tuberculosis is endemic. It is difficult to differentiate parotid tumours from tuberculous parotitis due to similar presentation. Although rare, tuberculous parotitis should always be kept as a differential diagnosis of tumours that increase parotid volume. We present a similar case of 17 years female with tuberculous parotitis mimicking parotid tumour. Case Report A 17 year old female presented with right preauricular swelling since 2 years. She had no history of pain, fever or weight loss. No history of Koch’s or Koch’s contact. On examination there was a swelling in the right preauricular region, measuring 2 x 2 cms, with well defined margins, smooth surface and firm in consistency. It appeared free from skin and underlying structures. No neck nodes were palpable. There were no signs of facial nerve palsy. Ultrasonography (USG) of the local part was suggestive of 2 x 2 cm heterogeneous lesion in right parotid. All routine investigations were within normal limits apart from ESR-45 mm at one hour. X-ray chest was within normal limit. A provisional diagnosis of pleomorphic adenoma was considered. Fine needle aspiration cytology (FNAC) was inconclusive. Patient was posted for superficial parotidectomy. Intraoperatively there was a 2 x 2 cm nodule in parotid, on dissection cheesy material came out of the swelling. A superficial parotidectomy was done and specimen sent for histopathological and microbiological examination. Histopathological examination of the swelling was suggestive of a tubercular infection of parotid with caseation seen with lymphocytosis and Langhan’s giant cell and epitheloid cells (Figs. 1 and 2). On culture sensitivity of the aspirate no organism was isolated. Patient was started on four drug Antikoch’s treatment (AKT) (i.e. isoniazid, rifampicin, pyrazinamide, ethambutol) for two months followed by two drugs (i.e. isoniazid, rifampicin) for four months. Patient was on follow up for six months. Patient recovered well and had no complains or recurrence.