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.