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Radiology Forum
December 2000

Imaging Quiz Case 3

Arch Otolaryngol Head Neck Surg. 2000;126(12):1501-1505. doi:

Pathologic evaluation confirmed the presence of acid-fast bacilli in the soft tissues of the neck mass, with no evidence of malignant or benign neoplastic disease. There was extensive, necrotizing granulomatous inflammation involving the surrounding skeletal muscle, fibrous connective tissue, and skin, but no evidence of teratoma or of the original testicular mixed germ cell tumor.

There is a well-described association of cervical tuberculous lymphadenopathy, or scrofula, with immunosuppressive therapy, such as chemotherapeutic treatment.1,2 Also, some authors have reported cases of scrofula in patients who were specifically treated with chemotherapy for germ cell neoplasms, such as gestational trophoblastic disease or testicular neoplasms.3,4 Immunosuppression may allow an underlying or undiagnosed tuberculous infection to spread systemically and present as cervical lymphadenopathy. In this case, the patient had no history of pulmonary tuberculosis and had not undergone a tuberculin (purified protein derivative) test before surgery. He was presumed to have a recurrence of his metastatic supraclavicular disease, or a residual teratoma.

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