Maxillofacial Squamous Cell Carcinoma With Cervical Metastasis and Tuberculous Lymphadenitis: Diagnostic Dilemmas and Clinical Insights

BACKGROUND: Maxillofacial squamous cell carcinoma (SCC) typically metastasizes to lymph nodes, yet coexisting tuberculous lymphadenitis is extraordinarily rare, posing diagnostic challenges. CASE: A 68-year-old female with right maxillofacial SCC and ipsilateral lymphadenopathy underwent radical resection and selective neck dissection after computed tomography had shown nodes with central necrosis and rim enhancement-features indeterminate for metastasis versus infection. Histopathological examination of the dissected lymph nodes revealed concurrent metastatic SCC foci and tuberculous granulomas. Further tuberculosis-specific tests returned positive results, confirming the final diagnosis of metastatic maxillofacial SCC with coexisting tuberculous lymphadenitis. Notably, the patient had no tuberculosis-related symptoms, with tuberculous lymphadenitis unsuspected preoperatively, underscoring the diagnostic challenge of such coexisting conditions. CONCLUSIONS: This case highlights the importance of considering infectious comorbidities, particularly in cases with atypical imaging or clinical manifestations, when evaluating lymph node lesions in cancer patients to avoid misdiagnosis and optimize therapeutic strategies.