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Case of the Month

September 2014

Patient Data: Female patient 75 years old

Clinical Info: Patient had been treated for a malignant lymphoma and now has a mass in tneck


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Well defined mass in the periphery of the submandibular gland


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There are only normal lymph nodes in the rest of the neck


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Detail of the mass


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The mass is vascularized


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Magnification


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Another magnification. Instead of a core biopsy by us, the referring physician did a cytological puncture (FNA) that was not conclusive but was interpreted as probably benign


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A few moths later the vascularity of the mass has changed. Does this change your diagnosis


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Another image of the mass


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There is only vascularity in the periphery mimicking an abscess or an infected cyst filled with thick material. Does this correspond with the first images???


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Puncture. No pus or other fluid was aspirated and a core biopsy was performed

With patients with a known malignancy allways be aware of the possibility of malignant lymph nodes. The nodes can be very well defined and when located in the periphery of a salivary gland can be mistaken for a benign mass. A biopsy should always be performed and a non conclusive puncture is not sufficient to exlcude a malignancy. Always perform another puncture untill it is conclusive. The node in this case underwent necrotic changes with only vital tissue at the periphery mimicking it an abscess The biopsy proved it to be a local recurrence of the malignant lymphoma

For more examples of malignant lymph nodes see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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