He is found to have perihilar lymphadenopathy. What is the most probable dx?

A pt comes with 6m hx of painless bilateral swelling of the face which has been
progressively increasing in size. On routine CXR, he is found to have perihilar lymphadenopathy. What is the most probable dx?

a. Chronic sialadenitis
b. Thyroid adenoma
c. Carcinoma of salivary gland
d. Adenoid cystic carcinoma
e. Mikulicz’s disease

Clincher(s) 6m , painless bilateral swelling of face , perihilar lymph adenopathy
A ChronicSialadenitis-refers to inflammation of a salivary gland and may be acute or
chronic, infective or autoimmune in parotid ,sub-mandibular and lingual gland,80%
pathology occurs in parotid
B Thyroid adenoma-swelling loacted over neck
Chronic bilateral symptoms may coexist with dry eyes and mouth and autoimmune
disease,eg hypothyroidism, Mikulicz’s or Sjogren’s
C Carcinoma of salivary gland-Carcinomas: Rapid growth; hard fi xed mass; pain
&VIIthnerve palsy.Surgery

  • radiotherapy. PET scan is better than CT and MRI for staging, detecting
    local recurrence and regional lymph node and distant metastases.
    D Adenoid cystic carcinoma-: Rare tumour of exocrine mucous glands (salivary, lacrimal,
    lid).slow growing mass+ late recurrences + perineural in fi ltration+ distant
    mets. Survival: 88%, 69% and 52% at 5, 10 and 15yrs. Follow-up:for life.
    From ohcs
    E • Mikulicz’sdisease( variant of sjogrensynd)-Symmetric , persistent swelling of
    lacrimal and parotid gland. (By exclusion)
    • It is diagnosed when -Sarcoidosis (note, Heerfordt’s syndrome =
    sarcoidosis with parotid enlargement, fever,anterior uveitis, and facial
    nerve palsy). And others such as ,viral infection, tb, sjogren syndrome ,
    lymphoproliferative disorders are excluded