BorisJ87

Infectious Diseases

An 81-year old gentleman was referred to my office because of the history of 3 months of progressive swelling in the left neck area. He didn't go to the doctor for two months. After that period he was seen by a surgeon; a CT of the neck and chest was performed which showed a big heterodense lobulated mass in the left neck area and supraclavicular area which corresponds to pathologically changed lymph nodes, with an axial diameter of 10x4 cm, and CC diameter of 16 cm. In the distal part of the left jugular chain and supraclavicularly, pathologically changed individual lymph nodes with a diameter of 2.2 mm were seen. In both axillae, reactive lymph nodes were seen. There was also panlobular emphysema of the lungs. After CT, a biopsy was performed and the PH examination showed "chronic inflammation of the connective-adipose tissue". He was given courses of gentamicin and ciprofloxacin for a short time during which he had slight improvement of swelling. He complained of pain in both axillae. He did not have night sweats, chills, pruritus, or fever.

PHx:

• No chronic diseases.

SHx:

• He was smoking for 40 years, half a pack per day, and he drank alcoholic drinks occasionally.

PE:

• A large indurated hard mass of the left neck area and supraclavicular fossa, not tender (white mark on the 2nd picture), and bilateral axillary tender lymphadenopathy (3rd picture).

Thoughts?

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