BH: In a 35-year-old female, a hypoechoic lesion 35 mm × 15 mm in size with a cystic appearance was detected during the US due to the presence of a palpable mass in the left neck. During the US, it was noted that the cyst had no septa inside, its wall was thin, and the lesion of the cyst was almost completely full. Cytologic findings: squamous epithelial cells were observed between sporadic inflamed cells on a dirty cystic background. It was noted that some squamous cells had dyskaryotic structures with pyknotic nuclei while reactive atypia was observed in a few cells []. Cytologic diagnosis: Branchial cyst.\nTHM: the cytopathologist noted that the lesion was cystic, and 10 cc of clear yellow fluid was obtained from the aspiration, during which the lesion shrank, which suggested that it could be a thin-wall cystic lesion. Cytodifferential diagnosis: Salivary gland lesion (e.g., Warthin tumor), cystic hygroma, cystic thyroid lesions, purulent inflammation (apsis) and metastasis of cystic squamous cell carcinoma (larynx, head/neck associated). In addition, squamous cell carcinoma cases associated with branchial cysts were defined in the literature.[]
BH: a 42-year-old female was referred to us for FNA due to her thyroid nodule. The US showed a multinodular goiter. A microcalcified nodule 16 mm × 11 mm in size in the right thyroid lobe was considered important; a US-FNA was performed. Cytologic findings and diagnosis: Smears presented typical findings of thyroid papillary carcinoma []. Surgery and afterward: After a certain period, the patient angrily came to my office with the pathology report in her hand, trying to reproach me by saying; “It turned out to be benign after surgery. You told me it was cancer; you made me go through this stress.” I gave the preparations to the patient and directed her to the pathology institution that had reported that her nodule was benign.\nThe FNA slides received the diagnosis of “papillary carcinoma” during the consultation at the institution. Consequently, the thyroidectomy specimen was sampled again. It was determined that a nodule that was overlooked and not sampled the first time turned out to be “papillary carcinoma.”\nThe thyroidectomy material was sent to pathology from the operation theater with the note reading “multinodular goiter + total thyroidectomy.” The information of malignancy at FNA was not specified.\nTHM: (1) If the patient had accepted the pathology report and not taken into account the FNA result, she could have experienced eventual metastasis because she would not have received radioactive iodine therapy and would not have been monitored. (2) Following the first pathology report, the surgeon did not take into account the incompatibility between the cytological and histological diagnoses. When the patient investigated herself, her condition turned out to be “real.”