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 41-year-old male presented with multiple LNs in the right neck; the largest ones were 32 mm × 20 mm in the right submandibular region and 35 mm × 15 mm and 25 mm × 20 mm in the right neck. A positron emission tomography-computed tomography (PET-CT) scan showed involvement with suspicions of malignancy in the stomach wall and the LNs. Clinical preliminary diagnosis: stomach cancer with metastasis to the neck LNs. Cytologic findings: US-FNA was used in the three LNs in the neck. Similar characteristics were observed in all LNs: Pleomorphic malignant cells represented individually in some areas and forming clusters in others were formed on a partially eosinophilic reactive lymphoid background. The nuclei of malignant cells were large, and the cytoplasm was wide and vacuolated. Enlarged nucleoli were observed in some cells []. Cytologic diagnosis: Undifferentiated malignant tumor cells. Comment: malignant cells with a pleomorphic nature were observed admixed with reactive lymphoid cells and eosinophilia. The cellular characteristics resembled adenocarcinoma, as suspected clinically. However, due to multiple large LNs that were identified during US, pleomorphic cells also resembled “lacunar cells” seen in “nodular sclerosing type Hodgkin's lymphoma.” Histopathology: Nodular sclerosing type Hodgkin's lymphoma.\nTHM: (1) Despite the suspicion of “gastric cancer” due to the PET-CT results, the radiologist warned about multiple LNs during the US-FNA. (2) Lacunar cells from Hodgkin's lymphoma obtained through FNA may be confused with carcinoma, melanoma, germ cell tumor, and sarcoma.[]