Unusual CT finding in neck lymph node involved by lymphoma

Abstract

Squamous cell carcinoma is the most common malignant lesion in the head and neck. Although neck adenopathy is generally thought to be a metastasis from a primary soite. On the other hand, lymphoma is the most common primary malignancy in the extralaryngeal portion of the neck and is the most frequent cause of unilateral neck mass in patients 20-40 years of age. In contrast to squamous ceil carcinoma, lymph nodes involved by lymphoma usually do not show central necrosis before treatment. A 76-year-old woman was referred to our hospital with a chief complaint of pharyngeal pain in January 1992. Physical examination revealed diffuse swelling at the base of the tongue. MRI showed that the suspected tumor mass lesion was located at the left base of the tongue and tonsillar pillar (Fig, 1). Axial CT image showed a clear central necrotic finding at the left upper neck (Fig. 2) which was suggestive of primary squamous cell carcinoma involving the tongue and tonsillar pillar with metastasis to a neck lymph node. However, histopathological examination of a biopsy specimen indicated nonHodgkin's lymphoma.