Verkäsend-tuberkuloide Nekrosen in Halslymphknoten. Sonographie nach Radiochemotherapie eines undifferenzierten Nasopharynxkarzinoms

UNLABELLED: Sonography following Radiochemotherapy for Undifferentiated Nasopharyngeal Carcinoma:

AIM AND METHOD: An undifferentiated nasopharyngeal carcinoma (UCNT) recurred 5 1/2 months after radiochemotherapy in a 14-year-old Caucasian boy. By ultrasound, multiple lymph nodes, predominantly left sided, were identified both in groups and singly located adjacent to large cervical vessels.

RESULTS: After lymphadenectomy, pathological examination revealed caseation necrosis with epitheloid cells and Langhans [corrected] cells in 2 of 6 enlarged lymph nodes (> 10 mm). The tentative diagnosis of tuberculosis was excluded during (3 years) follow-up.

CONCLUSION: Caseation necrosis in lymph node metastases is highly characteristic of UCNT. Sonography failed in the case described to demonstrate differences in lymph nodes with and without caseation necrosis. Differential diagnosis between tuberculous and metastatic cervical lymph nodes must therefore be made by other means (serology, microbiology).