case_images: PMC6445037_01
case_images: Transverse sonogram of the right upper neck revealed multiple matted, ovoid, hypoechoic, homogenous, and enlarged lymph nodes (arrow) below the right parotid gland
case_images: JMU-27-43-g001.jpg
case_images: PMC6445037_01_JMU-27-43-g001.jpg
case_images: F1
case_images: MHz broadband linear array transducer [Video]. Multiple matted, ovoid, homogenous, hypoechoic and enlarged lymph nodes [Figure 1] were seen below the right parotid gland.
case_images: Sonogram of the right parotid gland shows heterogeneous echotexture with small and indistinct hypoechoic nodules. Similar findings are found over the left parotid and bilateral submandibular glands
case_images: JMU-27-43-g002.jpg
case_images: PMC6445037_01_JMU-27-43-g002.jpg
case_images: F2
case_images: There was also heterogeneous echotextures with small and indistinct hypoechoic nodules over bilateral parotid and submandibular glands [Figure 2].
case_images: A photograph of histopathology shows retained nodal architecture and lymphoid follicles variable in size, with tangible-body macrophages in germinal centers. There are scattered plasma cells in germinal centers, and mildly increased plasma cells in interfollicular areas. A focal germinal center penetrated by a blood vessel is noted (H and E, x40)
case_images: JMU-27-43-g003.jpg
case_images: PMC6445037_01_JMU-27-43-g003.jpg
case_images: F3
case_images: The pathology of excisional biopsy specimens revealed reactive hyperplasia with scattered plasma cells in germinal centers and mildly increased plasma cells in interfollicular areas [Figure 3].
case_images: A photograph of limmunohistochemistry for IgG and IgG4 reveal that the ratio of IgG4+/IgG+ plasma cell is >40%, which is suggestive of IgG4-related lymphadenopathy (x200 IgG4 immunostain)
case_images: JMU-27-43-g004.jpg
case_images: PMC6445037_01_JMU-27-43-g004.jpg
case_images: F4
case_images: Immunostainings for IgG and IgG4 revealed that the ratio of IgG4+/IgG+ plasma cells were >40% [Figure 4].