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Have swollen lymph node in submandibular region. Proper diagnosis and required treatment?

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Practicing since : 1999
Answered : 711 Questions
Question: What is the diagnosis of the following and line of treatment you suggest:

FNAC of Right Submandibular swelling : Smears show predominantly lymphocytes and occasional neutrophils. Few granulomas composed of epitheolioid cells, lymphocytes are seen against a haemorrhagic background.
Aggregates of histocytes are also seen.
Malignant cells are not seen.
Stain for Acid Fast Bacilli is negative.

Sonography reveals the following: 3.00 *2.13*1.74 cm size, solid, well defined, homogenously hypoechoeic swelling is noted in the right submandibular region, antero superior to the right submandibular salivary gland.
The swelling shows a hilum & mild vascularity.
1.01 & 0.84 cm size, two other enlarged nodes are noted in the neck adjacent & lateral to the palpable swelling.
There is no evidence of any other swelling in the neck.
The salivary glands show no abnormality.
The Thyroid glands show no abnormality.
The major vessels show no abnormality.
Remarks: Lymph node swelling in the right submandibular region.
Posted Mon, 11 Mar 2013 in General Health
Answered by Dr. Samik Basu 2 hours later
Hi ,
Thank you for your query.
This is a case of granulomatous lymphadenopathy.
The commonest cause being tuberculosis.Do not panic.
But some more investigations are needed to confirm the diagnosis.
You need to do an ESR ,Mantoux test, Chest X XXXXXXX and Sputum for TB bacilli.
The Gold standard would be excision biopsy of the gland with RNA PCR culture .
If it reveals tuberculosis then the treatment would be anti-tubercular therapy which would provide complete remission of the disease.
If you have any further queries you are free to consult me.
Hope this answers your query.
Wishing your child a speedy recovery.
Have a nice day.
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