BH: A 20-year-old male had a mobile soft mass with a diameter of 30 mm that had been present for 6–7 months in the right supraclavicular region. Numerous LNs with diameters of 25, 25, and 15 mm were also detected in the right cervical region during the US. A US-FNA was performed. Cytologic findings: a heteromorphic structure composed of small-large lymphocytes and few eosinophils was observed. Sporadic and scattered epithelioid histiocytes and epithelioid histiocytic groups forming granuloma-like structures were noted on a reactive lymphoid background. “Atypical mononuclear cells with an undefined nature” were observed in the regions adjacent to these groups. Necrosis and typical granulomas were not observed []. Cytologic diagnosis and remarks lymphoid proliferation comprising a granulomatous reaction, which may be a component of granulomatous lymphadenitis (e.g., tuberculosis/sarcoid) or the reflection of an underlying neoplasia/lymphoproliferative lesion (Hodgkin's lymphoma) not represented by FNA. Histopathology: Mixed type Hodgkin's lymphoma.
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.[]