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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 3  |  Issue : 1  |  Page : 124-126

Primary oro-pharyngeal tuberculosis mimicking as malignancy


1 Department of Head and Neck Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
2 Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
3 Department of Epidemiology and Biostatistics, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India

Date of Web Publication13-Apr-2015

Correspondence Address:
Dr. Nizara Baishya
Room No 26, OPD Block, Dr. B. Borooah Cancer Institute, Guwahati - 781 016, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.154963

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  Abstract 

Primary oropharyngeal tuberculosis is a rare entity and accounts for 0.05-5% of all cases of tuberculosis cases. We report here a case of 20-year-old female with primary oropharyngeal tuberculosis. The patient initially presented with an ulcer-proliferative growth on the right tonsil. Subsequently, after a delay of 6 months due to noncompliance of the advice given, she presented with extensive involvement of the oropharynx. The diagnosis of primary tuberculosis was made after histopathological examination and cytological examination for exclusion of acid-fast bacilli in the sputum and bronchoalveolar lavage fluid as well. In endemic region young patients presenting with ulcer-proliferative growth on oropharynx, a high degree of suspicion for tuberculosis should be made. Early diagnosis and prompt treatment with anti-tubercular drugs results in a good treatment outcome with complete resolution of symptoms and signs.

Keywords: Acid fast bacilli, malignancy, oropharynx, tuberculosis


How to cite this article:
Baishya N, Das AK, Sharma JD, Singh A, Krishnatreya M, Kataki AC. Primary oro-pharyngeal tuberculosis mimicking as malignancy. Arch Med Health Sci 2015;3:124-6

How to cite this URL:
Baishya N, Das AK, Sharma JD, Singh A, Krishnatreya M, Kataki AC. Primary oro-pharyngeal tuberculosis mimicking as malignancy. Arch Med Health Sci [serial online] 2015 [cited 2019 Dec 7];3:124-6. Available from: http://www.amhsjournal.org/text.asp?2015/3/1/124/154963


  Introduction Top


Tuberculosis is a highly infectious disease, which is caused by Mycobacterium tubercular bacilli. In developing countries, it is still one of the leading causes of morbidity and mortality. The disease mainly manifests as pulmonary form. Extra pulmonary infection involving lymph nodes, central nervous system, abdomen, genitourinary tract, bones and joints, and pleura are also seen. Primary tuberculosis of the oropharynx is rare, and it accounts for 0.05-5% of total tuberculosis cases. [1],[2] We report here a case of primary oropharyngeal tuberculosis, which clinically mimicked a malignancy of the oropharynx, its diagnosis and response to treatment.


  Case Report Top


A 20-year-old female patient presented at the outpatient department of ear, nose, throat, and head and neck surgery with the chief complaints of sore throat, and off and on throat pain of 6 months duration. There was no history of cough, fever, and hemoptysis. The patient was a nonsmoker and nonalcoholic, but she had a history of consuming chewable betel nut. There was no history of contact with tuberculosis patients.

On general examination, the patient was thin built which was suggestive of poor nutritional status. There were no palpable neck nodes. On intra-oral examination, there was an ulcer-proliferative growth on the right tonsil. However, the patient defaulted investigations advised including biopsy and presented again after a period of 6 months. This time she presented with dysphagia and severe pain in the throat radiating to the ears. The patient was having fever and poor performance status, and on intra-oral examination, the ulcer-proliferative growth had increased in its size, which now was involving the soft palate, bilateral tonsils, base of the tongue, and lateral pharyngeal wall on the right side. There was a 2 cm × 2 cm firm, nontender and mobile lymph node on the right level II of the neck. Chest X-ray and ultrasonography abdomen were normal. Multiple punch biopsies were done from the ulcer-proliferative growth, which revealed features of a caseous granulomatous lesion suggestive of a tuberculous pathology [Figure 1]. No evidence of malignancy was seen on histopathological examination. Sputum examination for acid-fast bacilli (AFB) was negative. Serological tests for human immunodeficiency virus (HIV) were nonreactive. Fiber-optic bronchoscopy was done for bronchoalveolar lavage (BAL) for detecting AFB. However, the lavage fluid did not reveal AFB on cytological examination. The diagnosis of primary oropharyngeal tuberculosis was made.
Figure 1: Photomicrograph with H and E, (×10) showing a granuloma, scanty necrosis and Langhans giant cells

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The patient was put on anti-tubercular four drugs regimen. After 2 months commencement of treatment there was complete resolution of symptoms and disappearance of the lesion [Figure 2]. Furthermore, there was improvement in health and performance status of the patient.
Figure 2: (a) It shows the growth on the right tonsil involving the lateral pharyngeal wall and part of the soft palate (b) picture showing complete resolution of the lesion from the oro-pharynx after treatment with anti tubercular drugs

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  Discussion Top


Tubercular manifestation in the oropharynx is uncommon. The most common sub-site of involvement in the oral cavity is the tongue and in the oropharynx it is the tonsils followed by soft palate. [3],[4] In our case, initially the patient presented with limited involvement of the tonsil, but, at a later period due to noncompliance, the patient presented with an extensive involvement of the oropharynx with nodal enlargement and poor performance status. Lesions of primary oropharyngeal and oral tuberculosis generally occur in younger age group. [5] It has been reported in the literature that pediatric age group is more commonly involved. [6],[7],[8] Our patient was a female of 20 years of age. The tubercular lesion in our patient mimicked that of a malignant lesion. Tuberculosis of the oropharynx usually occurs secondary to pulmonary tuberculosis due to coughing up of infected sputum settling in the oropharynx. [9] Our case had no radiological evidence of pulmonary tuberculosis and also, the patients was negative for AFB on sputum examination. However, it has been shown that fiber-optic bronchoscopy and bronchial washings for AFB by cytological examination should be done to identify bacilli in sputum smear negative cases of pulmonary tuberculosis. [10] Moreover, in our case BAL for AFB was negative, so, it was confirmatory for primary oropharyngeal tuberculosis. Oro-pharyngeal tuberculosis has been reported in immunocompetent individuals, [11] like in our case who was serologically nonreactive for HIV. In head and neck lesions of tuberculosis, malignancy may co-exist, [12] so a careful tissue diagnosis should be done to exclude a co-existing carcinoma. In our case, multiple tissue biopsies did not revealed any features of malignancy in the oropharynx.


  Conclusion Top


Though the burden of tuberculosis is on the decline in India. [13] However, in an endemic region young patients presenting with ulcer-proliferative growth on the oropharynx, a high degree of suspicion for tuberculosis should be made. Diagnosis should be confirmed by histopathological examination, including exclusion of the pulmonary lesion by radiological examination and cytological examination for AFB. The response to anti-tubercular drug is good, so anti-tubercular drugs should be started as soon as the histopathological diagnosis of granulomatous lesion is made to minimize the morbidity.

 
  References Top

1.
Mignogna MD, Muzio LL, Favia G, Ruoppo E, Sammartino G, Zarrelli C, et al. Oral tuberculosis: A clinical evaluation of 42 cases. Oral Dis 2000;6:25-30.  Back to cited text no. 1
    
2.
Kant S, Verma SK, Sanjay. Isolated tonsil tuberculosis. Lung India 2008;25:163-4.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Neville B, Damm DD, Allen CM, Bouquet J, Neville BW. Oral and Maxillofacial Pathology. 2 nd ed. Philadelphia: WB Saunders; 2002. p. 458-61.  Back to cited text no. 3
    
4.
Hashimoto Y, Tanioka H. Primary tuberculosis of the tongue: Report of a case. J Oral Maxillofac Surg 1989;47:744-6.  Back to cited text no. 4
    
5.
Madhuri, Mohan C, Sharma ML. Posterior oro-pharyngeal wall tuberculosis. Indian J Otolaryngol Head Neck Surg 2002;54:152-3.  Back to cited text no. 5
    
6.
Ghatak S, Jana T, Bandopadhyaya S, Biswas SK. Primary oropharyngeal tuberculosis causing destruction of uvula-a rare presentation. Int J Pediatr Otorhinolaryngol 2010;5:91-2.  Back to cited text no. 6
    
7.
Prasad P, Bhardwaj M. Primary tuberculosis of tonsils: A case report. Case Rep Med 2012;2012:120382.  Back to cited text no. 7
    
8.
Chavolla R, Dolci GF, Hernadez JF, Ysunza A, Cuevas B, Lazos M, et al. Primary tuberculosis of the tonsil. Int J Pediatr Otorhinolaryngol Extra 2006;1:150-3.  Back to cited text no. 8
    
9.
Dadgarnia MH, Baradaranfar MH, Yazdani N, Kuohi A. Oropharyngeal tuberculosis: An unusual presentation. Acta Med Iran 2008;46:521-4.  Back to cited text no. 9
    
10.
Altaf Bachh A, Gupta R, Haq I, Varudkar HG. Diagnosing sputum/smear-negative pulmonary tuberculosis: Does fibre-optic bronchoscopy play a significant role? Lung India 2010;27:58-62.  Back to cited text no. 10
    
11.
Sá LC, Meirelles RC, Atherino CC, Fernandes JR, Ferraz FR. Laryngo-pharyngeal tuberculosis. Braz J Otorhinolaryngol 2007;73:862-6.  Back to cited text no. 11
    
12.
Krishnatreya M, Das K, Sarma A, Sharma JD. Primary laryngeal tuberculosis mimicking supraglottic carcinoma. Int J Case Rep Image 2013;4:354-7. Available from: http://www.ijcasereportsandimages.com. [Last cited on 2014 May 21].  Back to cited text no. 12
    
13.
Sachdeva KS, Kumar A, Dewan P, Kumar A, Satyanarayana S. New vision for Revised National Tuberculosis Control Programme (RNTCP): Universal access - "Reaching the un-reached". Indian J Med Res 2012;135:690-4.  Back to cited text no. 13
[PUBMED]  Medknow Journal  


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