A diagnostic pitfall on cervical ultrasound: Lipoplastic lymphadenopathy mimicking malignancy

Lipoplastic lymphadenopathy is an uncommon benign condition characterized by fatty replacement of lymphoid tissue with reactive hyperplasia, which can mimic malignant or granulomatous disease on imaging. We report a 25-year-old female presenting with a gradually enlarging posterior cervical swelling and low-grade fever. Ultrasound demonstrated multiple enlarged cervical lymph nodes with loss of the normal fatty hilum and heterogeneous features suggestive of malignancy, prompting excisional biopsy. Histopathological analysis revealed reactive follicles with fat metaplasia without evidence of malignancy, establishing the diagnosis of lipoplastic lymphadenopathy. This case highlights the limitations of imaging in differentiating benign from malignant lymphadenopathy and emphasizes the indispensable role of histopathology in achieving a definitive diagnosis. Awareness of benign nodal mimics is essential to avoid misdiagnosis, unnecessary interventions, and inappropriate management.