title: Metastatic squamous cell carcinoma presenting as diffuse and punctate cervical lymph node calcifications: sonographic features and utility of sonographically guided fine-needle aspiration biopsy.
abstract: 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.
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto and Department of Radiology, Stanford University School of Medicine, Stanford, California, USA. lshin@stanford.edu
authors.forename: Lewis K
authors.initials: LK
authors.lastname: Shin
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Fischbein
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Kaplan
authors.forename: R Brooke
authors.initials: RB
authors.lastname: Jeffrey
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology* / Q000556:secondary*; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D018084:Ultrasonography, Interventional / Q000379:methods*