case_images: PMC8329340_01
case_images: PMC8329340_02
case_images: Left neck mass. (A) Physical exam displayed a prominent, firm left neck mass, roughly 5 x 5 cm, which was immobile, non-tender, non-fluctuant and marked by a healed surgical scar. She had an additional small, healed, post-auricular surgical scar. (B) CT scan demonstrated a 5.4 x 3.7 x 6.3 cm, well-delineated, non-calcified, homogenous, non-necrotic nodal mass.
case_images: fped-09-674317-g0001.jpg
case_images: PMC8329340_02_fped-09-674317-g0001.jpg
case_images: F1
case_images: There was a prominent, firm, left neck mass (Figure 1A), roughly 5 x 5 cm, which was immobile, non-tender, non-fluctuant and marked by a healed surgical scar. Computed tomography (CT) imaging of the neck revealed left cervical chain lymphadenopathy, with a nodal mass measuring 5.4 x 3.7 x 6.3 cm (Figure 1B), and additional asymmetric nodes <1 cm scattered along the upper and lower left neck.
case_images: Histopathologic examination of left neck mass. (A) Hematoxylin and eosin (H&E)-stain showing lymphoid tissue with marked interfollicular expansion and reactive follicles (1.25x). (B) H&E-stain showing prominent eosinophilia and plasmacytosis together with plump endothelial cells (20x). (C) H&E-stain revealing a fibrotic process with elevated plasma cells and eosinophils (40x). (D) Abundant IgG4-stained cells (>60 per high powered field, 40x).
case_images: fped-09-674317-g0002.jpg
case_images: PMC8329340_02_fped-09-674317-g0002.jpg
case_images: F2