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A 32-year-old woman was referred to our ENT clinics for the evaluation of multiple symmetrical swellings in her neck. In the patient's family history, there was cross-cousin marriage between her grandparents. The patient and her sister had severe hearing loss and type 1 diabetes mellitus since their childhood. The patient also had symmetric hyperpigmented and erythema nodosum-like lesions on the anterior surface of the lower extremities which would suggest that she has an immune system disorder (Figure 1a). The head and neck examination revealed bilateral symmetrical firm, painless, and fairly mobile periparotid and submandibulary masses (Figure 1b). Magnetic resonance imaging (MRI) scans on the neck revealed conglomerated lymph nodes of a size 45x27 mm on the right parotid region and 37x22 mm on the left and also a solid lymph node of a size 26x18 mm on the right submandibular region and 21x18 on the left. According to the patient's blood sample tests, C-reactive protein and rythrocyte sedimentation rate were high, while capillary protein electrophoresis showed polyclonal hypergammaglobulinemia. Antithyroglobulin, anti-thyroid peroxidase, and anti-nuclear antigen were also positive. The patient's cardiac MRI showed that there was a uniform contoured mass lesion which is adherent to the

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