Extensive tubercular neck lymphadenopathy in a man with early-stage tongue cancer.

BACKGROUND: A 66-year-old Asian man presented with a tongue ulcer and without palpable metastases to the neck nodes. A thorough clinical examination of the head and neck region did not reveal any other primary lesion. To assess the status of the neck, PET-CT imaging was advised. INVESTIGATIONS: Physical examination, punch biopsy, PET-CT imaging, blood tests, chest radiograph, fine-needle aspiration biopsy, tumor biopsy, neck incision, tuberculin test, sputum culture and histopathology. DIAGNOSIS: Carcinoma of the tongue of pathologic stage T2 N0 M0, with tubercular lymphadenitis and no nodal metastases. MANAGEMENT: Surgical excision and multidrug antitubercular therapy.