LATERAL NECK SWELLING: DIAGNOSTIC PROBABILITIES? sejalgrover98@gmail.com

PE038

LATERAL NECK SWELLING: DIAGNOSTIC PROBABILITIES?

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India

Oral or Poster

A swelling in the neck is an enigmatic visible altercation, which brings forth a plethora of diagnostic probabilities. There is but just a miniscule chance that it could be a squamous cell carcinoma of submandibular gland, which accounts for less than 5% of submandibular gland tumors.

A 47 year old male patient presented to routine OPD with complaint of painless lateral neck swelling, progressively increasing in size since the past 3 years. Patient is a chronic tobacco chewer. Ultrasonography of neck was suggestive of enlarged submandibular lymph node of Level Ib measuring 3.1 x 1.9 x 2.3 cm. MRI was s/o of the same lesion being iso-intense on T1 weighted images and intravenous administration of Gd-DTPA, with thick peripheral enhancement, causing mass effect medially on left submandibular gland. FNAC of the lymph node was s/o metastasis of squamous cell carcinoma. FDG PET-CT findings s/o low-grade metabolically active lesion with internal solid cystic component arising from left submandibular gland, is a site of primary neoplastic disease. Supra-omohyoid neck dissection along with submandibular gland excision was done for this patient, with uneventful surgical and post-operative period.

Final histopathology report was suggestive of squamous cell carcinoma of thymic cyst with normal submandibular gland morphology.

It is important to keep one’s mind open to all diagnostic probabilities in the case of neck swellings. Inspite of advanced imaging techniques and pre-operative histopathological reporting, the final diagnosis can be full of surprises