Female patient 23 yo detected submandibilar nodes with history of recurrent sore throat. And some palpable left cervical nodes along of SCM. No fever, nor pain.
US 1: hypoechoic, no hilus left submandibular nodes.
US 2: scanning along left site SCM, small hypoechoic nodes.
US 3: hypervascular color Doppler .
US 4. high flow vascular intranodes without defected area.
US 5: spectral Doppler high RI and PI.
US 6: elastoscanning of inhomogeneous nodes, central low kPa.
Biopsy of the big submandibular node.
Blood tests= normalWBC, CRP, but high beta microglobuline 3200 UI, and normal LDH, ferritine.
What do you suggest for the case?