Clinically unexpected lymph node: An old enemy to remember in the cancer diagnosis and treatment

In the absence of axillary lymph node involvement, the thyroid nodule and cervical lymph nodes made us concern about a second primary malignancy, most probably a thyroid neoplasm. Thyroid fine needle aspiration biopsy showed normal thyroid glands and tru-cut biopsy of the right supraclavicular lymph node showed granulomatous lymphadenitis which is consistent with tuberculosis lymphadenitis (Figure 2A). The PPD test measured 15 mm and serum quantiferon were positive. The patient was consulted to the infectious disease department and an initial intensive-phase therapy with four antibiotics (INH, RIF, PZA, EMB) and continuation-phase therapy with 2 antibiotics (INH, RFA) planned.