Brief history (BH): a 43-year-old female presented with a palpable mass in the right neck. US revealed a 20 mm × 15 mm hypoechogenic lymph node (LN) in the right cervical jugular region. During US-FNA, 3 cc of hemorrhagic cystic fluid was obtained. It was believed that the cystic LN could be associated with papillary thyroid carcinoma. US was performed on the thyroid, which had not previously undergone US. The radiologist detected an 8 mm × 6 mm microcalcified nodule in the right lobe. FNA was also performed on this nodule.\nCytologic findings: (i) LN: smears from cystic fluid showed clusters of atypical thyroid follicular cells on a cystic background with hemosiderin-laden macrophages. (ii) Thyroid nodule: the hypercellular samples revealed atypical papillary clusters with occasional intranuclear vacuoles and grooves []. Cytologic diagnosis: LN: Metastasis of cystic papillary thyroid carcinoma. Right thyroid nodule: Thyroid papillary carcinoma. The cytologic diagnosis was confirmed histopathologically.\nTHMs: After the fluid was obtained from the LN during the FNA, “metastasis of thyroid papillary carcinoma,” which comes to mind first in the differential diagnosis of lesions that form cystic degenerations at the LN, was considered.[] Other lesions included in the differential diagnosis were hemangioma, metastasis from malignity in the salivary gland, squamous cell carcinoma, and malignant melanoma.[]
BH: an FNA was requested for a 45-year-old female patient with multiple sclerosis due to the presence of an LN in the neck. Multiple LNs, the largest of which was 3 cm, were detected during the US. A US-FNA was performed on the dominant LN located in the left cervical region. Cytologic findings: homogenously spread monomorphic, large, round, atypical lymphoid cells were detected []. Cytologic diagnosis: Non-Hodgkin's lymphoma. Surgical biopsy and afterward: The biopsy from the neck was reported to be a “sebaceous cyst.” I wrote a letter to her physician and emphasized that there were bilateral multiple LNs in the neck and that the FNA picture did not reflect a “sebaceous cyst” at all. I called the patient 5 months later. After receiving my note, her physician excised the LN on which I had performed the FNA. The patient was diagnosed with “diffuse large B-cell lymphoma” and received treatment. It turned out that the mass described as a “sebaceous cyst” was removed by the physician, as it was easy to remove from the surface of the opposite side of the LNs that underwent FNA!