BH: A 6-year-old male had an LN 30 mm in diameter in the right submandibular region and multiple LNs, the largest of which measured 25 mm and 15 mm, in the right cervicojugular region. US findings: Compatible with abscess/necrotic appearance. A US-FNA was performed on the largest LN (3 cm in size) in the right submandibular region. The procedure could not be repeated on the other LNs, as the pediatric patient could not be controlled.\nCytologic findings: Epithelioid histiocytes, epithelioid histiocytic granulomas, and Langhans-type giant cells were observed adjacent to a cell population with a high number of large atypical lymphoid cells []. Cytologic diagnosis: atypical lymphoid proliferation comprising granulomatous structures. Comment: granulomatous structures may be components of granulomatous inflammation (e.g., tuberculosis, sarcoid) or may develop secondarily to a lymphoproliferative lesion or carcinoma metastasis. Histopathology: Burkitt lymphoma with secondary granulomatous inflammatory foci (no information could be obtained regarding the cause of granulomatous inflammation proposed in histopathological diagnosis).\nTHM: (1) In the absence of typical cytological components of granulomatous inflammation, individually or sporadically represented epithelioid histiocytes and granuloma-like structures are not sufficient for the diagnosis of “granulomatous inflammation.” (2) In such cases, it would be more appropriate to write “granulomatous reaction” and add a remark in a similar context like our above-mentioned comment. (3) Granulomatous reactions and granulomas are not usually expected to accompany non-Hodgkin's lymphoma; they mostly accompany Hodgkin's lymphoma.[]
BH: In a 35-year-old female, a hypoechoic lesion 35 mm × 15 mm in size with a cystic appearance was detected during the US due to the presence of a palpable mass in the left neck. During the US, it was noted that the cyst had no septa inside, its wall was thin, and the lesion of the cyst was almost completely full. Cytologic findings: squamous epithelial cells were observed between sporadic inflamed cells on a dirty cystic background. It was noted that some squamous cells had dyskaryotic structures with pyknotic nuclei while reactive atypia was observed in a few cells []. Cytologic diagnosis: Branchial cyst.\nTHM: the cytopathologist noted that the lesion was cystic, and 10 cc of clear yellow fluid was obtained from the aspiration, during which the lesion shrank, which suggested that it could be a thin-wall cystic lesion. Cytodifferential diagnosis: Salivary gland lesion (e.g., Warthin tumor), cystic hygroma, cystic thyroid lesions, purulent inflammation (apsis) and metastasis of cystic squamous cell carcinoma (larynx, head/neck associated). In addition, squamous cell carcinoma cases associated with branchial cysts were defined in the literature.[]