A 74-year-old white male resident of a long-term care facility presented with a 5-month history of slowly enlarging, bilateral, nonpainful cervical masses. His medical history included chronic paranoid schizophrenia, chronic obstructive pulmonary disease, a remote history of tuberculosis (TB), and a history of cigarette smoking.
Examination revealed a 3 × 2-cm, level 4, right cervical mass and a 3 × 3-cm, level 3, left cervical mass (Figure 1). Both masses were firm, mobile, nontender, and without overlying skin changes. The rest of the head and neck examination revealed no abnormalities other than poor dentition.