September 2014

Well defined mass in the periphery of the submandibular gland

Clinical Info

Patient had been treated for a malignant lymphoma and now has a mass in the neck.

Ultrasound Images & Clips

Well defined mass in the periphery of the submandibular gland

Well defined mass in the periphery of the submandibular gland
Well defined mass in the periphery of the submandibular gland
There are only normal lymph nodes in the rest of the neck
There are only normal lymph nodes in the rest of the neck
Detail of the mass
Detail of the mass
The mass is vascularized
The mass is vascularized
Magnification
Magnification
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
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
A few moths later the vascularity of the mass has  changed. Does this change your diagnosis
A few moths later the vascularity of the mass has changed. Does this change your diagnosis
Another image of the mass
Another image of the mass
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???
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???
Puncture.
No pus or other fluid was aspirated and a core biopsy was performed
Puncture. No pus or other fluid was aspirated and a core biopsy was performed

Conclusion

With patients with a known malignancy always 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 exclude a malignancy. Always perform another puncture until 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.


Details

  • Sex: Female
  • Age: 75
  • Body part: Neck

Created with

  • Hitachi Ultrasound System