A Case Report of Diffuse Large B-cell Lymphoma Masquerading as Necrotizing Lymph Nodes: The Role of Core Needle Biopsy for Early Diagnosis

Complete lymph node necrosis is a rare condition. Excisional biopsy of infarcted lymph node could wrongly lead physicians to benign diagnoses such as Kikuchi-Fujimoto disease, while malignant lymphoma progresses.
A 33-year-old man was referred with gradual enlargement of a left submandibular mass which had recently become painful. The patient had no dysphagia, odynophagia, dysphonia, dyspnea, coughing, nasal obstruction, tooth ache or epistaxis. Three masses were detected by physical examination and computed tomography. There were no signs of malignancy in fine needle aspiration and excisional biopsy. The patient was finally diagnosed by core needle biopsy under ultrasonography guidance and a second excisional biopsy.
The core needle biopsy under ultrasonography guidance could help choosing the optimal lymph node among multiple necrotizing lymph nodes and would prevent more invasive procedures. We emphasize that physicians should keep a high clinical suspicion for lymphoma even if the initial excisional biopsy of an infarcted lymph node is negative.