PMC5894045_01
Low-frequency US image shows an enlarged left parotid gland with heterogeneous echotexture (arrow).
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On an ultrasound examination [(US), Philips HD11XE], the left parotid gland was massively enlarged and showed heterogeneous echotexture (Figure 1).
Color Doppler image of an enlarged gland shows few prominent vessels with low-resistance arterial waveforms.
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On color Doppler, few prominent vessels with a low-resistance arterial waveform were seen (Figure 2).
High-frequency US image shows enlarged cervical lymph nodes with preserved central fatty hilum and increased hilar vascularity.
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Also, multiple enlarged cervical lymph nodes were seen at level I, II, III, and IV on the left side, and at level II and III on the right, with preserved central hilum and increased hilar vascularity on color Doppler (Figure 3).
Plain axial CT image at the level of oropharynx shows an enlarged, isodense left parotid gland and enlarged cervical lymph nodes (arrows).
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homogenously hypodense (Figure 4).
Coronal reformatted contrast CT image of the neck reveals heterogeneous enhancement of the left parotid gland (thick arrow) and homogenous enhancement of involved lymph nodes (thin arrows).
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The enlarged lymph nodes showed homogenous intense enhancement without necrosis (Figure 5).
Axial T1W MRI image at same level as in Figure 4 shows an isointense left parotid gland (black arrow) and involved lymph nodes (white arrows).
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Tesla), the left parotid gland and lymph nodes appeared isointense on T1W images (Figure 6), hyperintense on T2W and STIR images (Figures 7, 8), and showed enhancement on post-contrast T1W images (Figure 9). The left parotid gland appeared more heterogeneous on T2W and STIR images, with patchy enhancement on post-contrast sequences.
Axial T2W image at the same level shows a heterogeneously hyperintense left parotid gland (black arrow) and homogenously hyperintense lymph nodes (white arrows).
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Tesla), the left parotid gland and lymph nodes appeared isointense on T1W images (Figure 6), hyperintense on T2W and STIR images (Figures 7, 8), and showed enhancement on post-contrast T1W images (Figure 9). The left parotid gland appeared more heterogeneous on T2W and STIR images, with patchy enhancement on post-contrast sequences.
Coronal STIR image shows hyperintense signal of involved areas.
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Tesla), the left parotid gland and lymph nodes appeared isointense on T1W images (Figure 6), hyperintense on T2W and STIR images (Figures 7, 8), and showed enhancement on post-contrast T1W images (Figure 9). The left parotid gland appeared more heterogeneous on T2W and STIR images, with patchy enhancement on post-contrast sequences.
Axial post-contrast T1W image reveals heterogeneous enhancement of the left parotid gland (black arrow) and homogenous enhancement of involved nodes (white arrows).
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Tesla), the left parotid gland and lymph nodes appeared isointense on T1W images (Figure 6), hyperintense on T2W and STIR images (Figures 7, 8), and showed enhancement on post-contrast T1W images (Figure 9). The left parotid gland appeared more heterogeneous on T2W and STIR images, with patchy enhancement on post-contrast sequences.
Axial DW image at b value of 800 shows decreased signal of the left parotid gland and increased signal in involved nodes.
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In contrast, the left parotid gland and the focal lesion in the right parotid gland showed dark signal on DWI, with increased ADC values (0.00199x10-3 mm2/s) (Figures 10, 11).
Color-coded ADC map at the same level shows increased diffusivity of the left parotid gland and restricted diffusion of involved nodes.
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In contrast, the left parotid gland and the focal lesion in the right parotid gland showed dark signal on DWI, with increased ADC values (0.00199x10-3 mm2/s) (Figures 10, 11).
Low-power (10x magnification) histopathologic section of the excised specimen after H&E staining shows multiple lymphoid follicles (arrows) with intervening areas of fibrosis.
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Dense mononuclear, particularly eosinophilic, cell infiltrate was noted (Figures 12, 13).
High-power (40x magnification) histopathologic section of the same slide shows numerous eosinophils (closed arrows) and multiple areas of fibrosis (open arrow) in addition to lymphoid infiltrate.
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Dense mononuclear, particularly eosinophilic, cell infiltrate was noted (Figures 12, 13).