PMC6445037_01
Transverse sonogram of the right upper neck revealed multiple matted, ovoid, hypoechoic, homogenous, and enlarged lymph nodes (arrow) below the right parotid gland
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F1
MHz broadband linear array transducer [Video]. Multiple matted, ovoid, homogenous, hypoechoic and enlarged lymph nodes [Figure 1] were seen below the right parotid gland.
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
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F2
There was also heterogeneous echotextures with small and indistinct hypoechoic nodules over bilateral parotid and submandibular glands [Figure 2].
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)
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F3
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].
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)
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F4
Immunostainings for IgG and IgG4 revealed that the ratio of IgG4+/IgG+ plasma cells were >40% [Figure 4].