case_images: PMC11833751_01
case_images: PET-CT scan findings. The black arrow shows lymphadenomegaly with hypermetabolism at the right level 2. PET-CT: positron emission tomography-computed tomography
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case_images: PMC11833751_01_cureus-0017-00000077649-i01.jpg
case_images: FIG1
case_images: Nine months after the completion of treatment, a PET-CT scan revealed a hypermetabolic lesion (SUVmax 19.1) in the right level 2 region of the neck (Figure 1).
case_images: MRI of the neck. (A) The red circle shows the right level 2 pathological lymph node axial section T2 sequence MRI image (B). The red circle shows the right level 2 pathological lymph node coronal section T2 sequence MRI image. MRI: magnetic resonance imaging
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case_images: PMC11833751_01_cureus-0017-00000077649-i02.jpg
case_images: FIG2
case_images: MRI of the neck showed a pathological lymph node in the right cervical jugular chain measuring 3 cm in craniocaudal length and 1 cm in maximum diameter (Figures 2A, 2B).
case_images: Biopsy and immunohistochemistry findings. (A) Distinct immunoblasts, increased vascularity, and eosinophilic cytoplasm with pyknotic nuclei in cells of immunoblast size, observed in the hyperplastic paracortex (hematoxylin & eosin x400); the red arrow indicates the CMV viral inclusion within the cell. (B) Immunohistochemical examination revealed cells showing positive immunoreactivity for CMV (CMV x200); the red circles indicate the immunoreactive CMV inclusions. CMV: cytomegalovirus
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case_images: PMC11833751_01_cureus-0017-00000077649-i03.jpg
case_images: FIG3
case_images: Additionally, large, dark, eosinophilic cytoplasmic inclusions with pyknotic nuclei, characteristic of eosinophilic viral nuclear inclusions, were identified (Figure 3A). Immunohistochemical analysis using an anti-CMV antibody revealed CMV-infected cells in some areas (Figure 3B).