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© 2009 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 28:1703-1707 • 0278-4297

Case Series

Metastatic Squamous Cell Carcinoma Presenting as Diffuse and Punctate Cervical Lymph Node Calcifications

Sonographic Features and Utility of Sonographically Guided Fine-Needle Aspiration Biopsy

Lewis K. Shin, MD, Nancy J. Fischbein, MD, Michael J. Kaplan, MD and R. Brooke Jeffrey, MD

Department of Radiology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California USA (L.K.S.); and Departments of Radiology (L.K.S., N.J.F., R.B.J.) and Otolaryngology (M.J.K.), Stanford University School of Medicine, Stanford, California USA.

Address correspondence to Lewis K. Shin, MD, Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305-5105 USA. E-mail: lshin{at}stanford.edu

Objective. The purpose of this series was to show the sonographic appearance of calcified cervical lymph nodes and the utility of sonographically guided fine-needle aspiration biopsy (FNAB) in the setting of metastatic squamous cell carcinoma (SCC). Methods. Two cases of confirmed metastatic SCC to cervical lymph nodes were identified. Sonography and sonographically guided FNAB were performed in both cases with positron emission tomography (PET)/computed tomography (CT) correlation. Results. In case 1, sonography identified a diffusely calcified, avascular cervical lymph node. Positron emission tomography/CT suggested granulomatous disease as a cause for hypermetabolism; however, sonographically guided FNAB identified metastatic SCC. In the second case, FNAB initially performed without sonographic guidance did not show malignancy. Subsequent FNAB with sonographic guidance identified an abnormal cervical lymph node with focal calcifications and internal color Doppler flow. Metastatic SCC was diagnosed on histopathologic examination. Subsequent PET/CT confirmed multiple punctate calcifications in a hypermetabolic lymph node. Conclusions. Calcifications in cervical lymph nodes from metastatic SCC are very rare. These 2 cases show the variable sonographic appearances and the utility of sonographically guided FNAB in establishing the correct diagnosis.

Key Words: calcified lymph node • cervical lymph node • fine-needle aspiration biopsy • metastasis • squamous cell carcinoma

Abbreviations: CT, computed tomography • FNAB, fine-needle aspiration biopsy • PET, positron emission tomography • SCC, squamous cell carcinoma

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