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 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.