摘要目的 分析头颈部黏膜结核的临床特征、影像学表现及其病理学改变,探讨其诊断.方法 对2011年收集的47例经病理证实的头颈部黏膜结核病例的临床、影像学和病理学资料作回顾性分析,并进行随访.结果 47例头颈部黏膜结核感染患者发病年龄14～84岁,平均年龄47.1岁,中位年龄45岁,男女比例1.23∶1；其中鼻腔3例,鼻咽部19例,口咽部2例,喉部18例,中耳4例,腮腺1例；1例喉结核同时伴发喉癌；首发症状分别为鼻塞、流涕、鼻衄、嗅觉减退、头痛、眼球胀痛、回缩血涕、咽喉部干痛、灼热、咳嗽、声嘶、耳道流脓、听力下降等；影像学显示局部黏膜增厚,软组织占位伴相应骨质破坏,间有密度不均的钙化；病理学特征为黏膜间质内有团状分布的类上皮细胞和郎罕巨细胞,伴有干酪样坏死,其中13例找到抗酸杆菌.随访3～ 10个月,5例失访.结论 头颈部黏膜结核因临床表现无特征性,多数无肺部或其他部位结核病史,容易漏诊和误诊.组织内发现团状分布的类上皮细胞、郎罕巨细胞和干酪样坏死是病理形态诊断的三要素,抗酸染色能找到结核杆菌,但是阳性率较低.头颈部黏膜结核应及时给予规范的抗结核治疗及全身性支持治疗并注意随访.

abstractsObjective To study the clinicopathologic features,histologic diagnosis and differential diagnosis of primary mucosal tuberculosis (TB) in the head and neck region.Methods Forty-seven cases of primary mucosal TB of the head and neck region were studied by hematoxylin-eosin and Ziehl-Neelsen stains.The clinical and pathologic features were analyzed with review of the literature.Results The patients included 26 male and 21 female,with mean age 47.1 years (range 14-84 years).There were three sinonasal TB,19 nasopharyngeal TB,two oropharyngeal TB,18 laryngeal TB,four middle ear TB,one salivary gland TB and one laryngeal TB complicating laryngeal cancer.The initial symptoms were nasal obstruction,mucopurulent rhinorrhea,epistaxis,snoring,hoarseness,dysphagia,odynophagia,serous otitis,hearing loss,tinnitus,and otalgia.Physical examination result was variable,from an apparently normal mucosa,to an evident mass,or a mucosa with an adenotic or swollen appearance,ulcers,leukoplakic areas,and various combinations thereof.CT and MRI findings included diffuse thickening,a soft-tissue mass,calcification within the mass and bone destruction resembling malignancy.Histologic examination showed granulomas with a central necrotic focus surrounded by epithelioid histiocytes and multinucleated Langhan's giant cells.Acid-fast bacilli were difficult to demonstrate but found in 13/45 cases.Follow-up data were available in 42 patients.Conclusions Primary TB arising in the head and neck mucosa is rare.It may mimic or co-exist with other conditions.The characteristic histopathology is a granuloma with central caseous necrosis and Langhans' giant cells.Identification of acid-fast bacilli and bacteriologic culture confirm the diagnosis of mycobacterial disease.