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HISTOPATHOLOGY SECTION - CASE REPORT Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 1  |  Page : 65-66
Primary tuberculosis of tongue


1 Department of Pathology, Regional Institute of Medical Sciences, Imphal 795 004, Manipur, India
2 Babina Diagnostic Centre, Regional Institute of Medical Sciences, Imphal 795 004, Manipur, India
3 Department of Surgery, Regional Institute of Medical Sciences, Imphal 795 004, Manipur, India

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   Abstract 

Primary tuberculosis of tongue is very rare with unusual presentation creating a diagnostic dilemma. We report a case of primary tuberculosis of tongue in a 49-year-old female patient. Tuberculosis was not suspected clinically and there was no other focus elsewhere in the body. Fine needle aspiration cytology was attempted but was inconclusive. The diagnosis was made after histopathological examination.

Keywords: Histopathology, tongue, tuberculosis

How to cite this article:
Sharma A B, Laishram D K, Sarma B. Primary tuberculosis of tongue. Indian J Pathol Microbiol 2008;51:65-6

How to cite this URL:
Sharma A B, Laishram D K, Sarma B. Primary tuberculosis of tongue. Indian J Pathol Microbiol [serial online] 2008 [cited 2014 Jul 10];51:65-6. Available from: http://www.ijpmonline.org/text.asp?2008/51/1/65/40402



   Introduction Top


Tuberculosis of tongue, whether primary or secondary, is quite rare. There have been isolated case reports in the literature. [1],[2],[3],[4],[5],[6],[7],[8] Most of the reported cases in the literature are in association with pulmonary lesion or a primary focus elsewhere. Often the clinical presentation may pose diagnostic difficulties. It is rare to suspect a nodule or ulcer in the tongue to be tuberculous on clinical examination. More often the diagnosis is made after fine needle aspiration cytology (FNAC) or histopathological examination of the lesion. Tuberculosis what we believe as primary of tongue in a 49-year-old female patient is presented.


   Case History Top


A 49-year-old female patient presented with a painless nonhealing nodule of 1.5 x 1 cm 2 size on the middle third, left dorso-lateral margin of tongue of 6 m duration. She was treated with antibiotics, local antiseptics, and vitamins with no improvement. There were no lymphadenopathy and organomegaly. Investigations revealed hemoglobin - 10 g/dl, total leukocyte count - 8600/cumm, differential leukocyte count: Neutro - 64%, Lympho - 30%, Mono - 4%, Eosino - 01%, and erythrocyte sedimentation rate-45 mm/first hour. Random blood sugar was 125 mg%. Chest X-ray was normal. Urinalysis and other biochemical parameters were normal. The FNAC was attempted, but yielded scanty cellular material mixed with blood. Biopsy was done. Grossly an irregular, grayish white solid tissue of 2 1.5 cm 2 was received and all embedded. Microscopic findings showed normal squamous epithelium overlying epithelioid granulomas with Langhans' giant cells, lymphocyte infiltration, and foci of caseous necrosis leading to the histopathological diagnosis of tuberculosis [Figure - 1]. Acid fast bacilli (AFB) by Z-N stain were, however, negative. Culture for Mycobacterium tuberculosis was not done because a preoperative diagnosis of tuberculosis was not made. Subsequently, Mantoux test was done and found to be positive (12 mm). Antimycobacterial antibody (Mycodot) test was positive for IgG (160 U/ml; interpretation being negative when <40 U/ml and positive when >120 U/ml). The patient has been given antitubercular treatment and remarkable improvement has been observed in 6 w.


   Discussion Top


Primary tuberculosis of oral cavity including tongue is very rare. It has been suggested that tongue involvement usually occurs due to contact with the infected sputum or by blood spread, or by direct contamination from the neighboring tuberculous focus in the oral cavity. A breach in the mucosa due to any reason is one of the important predisposing factors. [1] Weaver reported that 1-1.5% cases of pulmonary tuberculosis show tuberculosis of oral cavity, the sites most frequently affected are tongue, palate, tonsil, pharynx, and buccal mucosa. Nagar et al. [2] also reported a case of primary tuberculosis of palate. [3]

Panek et al. [4] described a case of tuberculosis of tongue associated with pulmonary lesion, diagnosed by thin-needle biopsy. [4] In the present case, FNAC was attempted yielding scanty cellular material mixed with blood. Biopsy was subsequently done for histopathological examination. Identification of AFB by Z-N stain is confirmatory, but this is frequently negative in tissue sections. [3],[5] The diagnosis thus rests on finding the typical granulomas and caseation necrosis of tuberculosis. In some cases, the diagnosis of lingual tuberculosis resulted in the detection of pulmonary lesion which is interpreted as blood-stream dissemination. Memon et al. [5],[6] also found a case of primary lingual tuberculosis which was diagnosed histopathologically after a second biopsy, the initial biopsy report was nonspecific inflammation. [7] We believe this to be primary tuberculosis of the tongue as we could not detect any other primary focus. Oral tuberculous lesions may take the form of nodules, ulcers, and elevated fissures. Ulcers are irregular with undermined edges, are painful and increase slowly. [8]

Clinically, the diagnosis of oral tuberculosis is not possible and histopathology provides a reliable diagnostic clue as in this case. Further, the diagnosis may be confirmed by detection of AFB and/or culture for M. tuberculosis . It is to be differentiated from nonspecific ulcerative lesions, traumatic lesions, and early malignant lesions. We need to be aware of this condition for early diagnosis and treatment.


   Acknowledgments Top


The authors express sincere gratitude to Dr. Dhabali Singh, Managing Director, Babina Diagnostic Centre, Imphal for valuable inputs and photomicrography.

 
   References Top

1.Ghose SM. Ulcers of tongue. J Indian Med Assoc 1966;41:377.  Back to cited text no. 1    
2.Weaver RA. Tuberculosis of tongue. JAMA 1976;235:2418.  Back to cited text no. 2    
3.Nagar RC, Joshi CP, Kanwar DL. Tuberculosis of oral cavity. Ind J Tub 1985;32:158-9.  Back to cited text no. 3    
4.Panek B, Chyczewska E, Miroz RM. Tuberculosis of the tongue. Pneumonol Alergol Pol 1999;67:477-80.  Back to cited text no. 4    
5.Aguirre Garcνa F, Fuertes Martνn A, Guillιn Guerrero VS, Santa Cruz Ruiz S, Fernαndez-Matamoros Garcνa I, Pιrez Liedo C, et al . Tongue tuberculosis as the first expression of the lung process. An Otorrinolaringol Iberno Am 2000;27:111-8.  Back to cited text no. 5    
6.Weichselbaumer W, Schmid E. Tuberculosis of tongue. Laryngol Rhinol Otol (Stuttg) 1976;55:726-9.  Back to cited text no. 6    
7.Memon GA, Khushk IA. Primary tuberculosis of tongue. J Coll Physicians Surg Pak 2003;13:604-5.  Back to cited text no. 7    
8.McAndrew PO, Adekeye EO, Ajdukiewicz AB. Miliary tuberculosis presenting with multi-focal oral lesions. BMJ 1976;1:1320.  Back to cited text no. 8    

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Correspondence Address:
A B Sharma
Department of Pathology, Regional Institute of Medical Sciences, Imphal 795 004, Manipur
India
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DOI: 10.4103/0377-4929.40402

PMID: 18417861

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    Abstract
    Introduction
    Case History
    Discussion
    Acknowledgments
    References
    Article Figures

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