Differential Diagnosis for a 7 cm Submandibular Node with Benign Characteristics on Ultrasound

• Single Most Likely Diagnosis
  • Benign lymphoid hyperplasia: This condition is characterized by an increase in the number of lymphocytes in the lymph node, often in response to infection or inflammation. A size of 7 cm is unusually large but can occur in chronic cases, and the benign characteristics on ultrasound support this diagnosis.
• Other Likely Diagnoses
  • Reactive lymphadenopathy: This is a common condition where lymph nodes become enlarged in response to infection, inflammation, or other stimuli. The size and benign ultrasound characteristics could fit this diagnosis, especially if the patient has a recent history of infection or inflammation in the head and neck area.
  • Lipoma or other benign soft tissue tumors: Although less common in the submandibular region, lipomas or other benign soft tissue tumors could present as a large, benign-appearing mass on ultrasound.
• Do Not Miss Diagnoses
  • Lymphoma: Although the ultrasound characteristics are benign, lymphoma can sometimes present with large lymph nodes that have a benign appearance on imaging. It's crucial to consider this diagnosis due to its significant implications for treatment and prognosis.
  • Metastatic disease: Certain cancers, particularly those originating in the head and neck, can metastasize to the submandibular lymph nodes. Even with benign ultrasound characteristics, the large size of the node warrants consideration of this potentially life-threatening condition.
• Rare Diagnoses
  • Kimura disease: A rare, chronic inflammatory disorder that can cause large submandibular lymphadenopathy. It's more common in Asian males and can be associated with eosinophilia and IgE elevation.
  • Castleman disease: A rare disorder that involves an overgrowth of cells in the lymph node. It can present with large lymphadenopathy and has different forms, some of which can be associated with serious complications if not treated properly.
  • Sarcoidosis: Although more commonly associated with pulmonary symptoms, sarcoidosis can cause lymphadenopathy, including in the submandibular region. The diagnosis would be supported by other systemic symptoms and findings consistent with sarcoidosis.