BH: A 65-year-old male presented with a 40 mm × 25 mm LN extending to the supraclavicular region in the right cervical chain in the neck. The right lung had a 3 cm area with a “ground-glass” appearance. Moreover, a cystic nodule 25 mm × 15 mm in size was present in the right thyroid. Clinical preliminary diagnosis was malignant; the primary focus was investigated (thyroid/lung?). US-FNA was applied to the LN and right thyroid nodule. The FNA of the thyroid nodule displayed findings compatible with “cystic degenerated adenomatous nodule.” LN cytologic findings: individually, scattered and sporadic groups of malignant cells were observed. The large cytoplasm cells had vacuoles and large, dark nuclei with sporadic pleomorphism []. Cytologic diagnosis: Adenocarcinoma. The diagnosis was interpreted as consistent with the metastasis of lung adenocarcinoma supported by the clinical/imaging picture. Follow-up: Diagnosis was confirmed by the histoimmunopathologic examination of the LN core biopsy.
BH: A 72-year-old female presented with a mass in the neck that had been present for 1 month. A 35 mm × 20 mm LN was observed in the left submandibular region during US, while 24 mm × 16 mm and 26 mm × 15 mm nodules were observed in the right thyroid isthmus and the left lobe, respectively. Clinical prediagnosis included lymphoma and metastasis; US-FNA was performed on all three lesions. Cytologic findings: LN: high numbers of pleomorphic, multinuclear, bizarre and undifferentiated cells were noted in the left submandibular mass []. Thyroid nodules: The findings were compatible with “adenomatous nodule” (FNA was performed in the same session to exclude thyroid malignancy). Cytologic diagnosis of the submandibular mass was “undifferentiated pleomorphic malignant tumor.” Histoimmunopathology: Anaplastic large cell lymphoma. THM: The detection of many multinuclear, large, “bizarre” cells led us to consider the presence of three lesions during the differential diagnosis: Anaplastic large cell lymphoma, melanoma and anaplastic carcinoma/sarcoma.