BH: A 50-year-old male presented with many bilateral LNs in the neck. Clinical preliminary diagnosis was lymphoma or metastasis. An assessment of the patient's file before the FNA MRI report revealed a description of a 22 mm × 18 mm asymmetrical mass lesion in the nasopharynx. Unfortunately, this information was not indicated on the FNA requisition form. US findings: the radiologist detected many conglomerated LNs in the right and left sides of the neck during the US before the FNA. An FNA was performed from the largest LNs located at the left and right supraclavicular regions, which were18 mm × 10 mm and 30 mm × 18 mm in size, respectively. Cytologic findings: malignant tumor cells were observed individually or in scattered groups on a lymphoid background and appeared reactive. Thin fusiform particles were detected inside the nucleus in some cells in malignant clusters []. Cytologic diagnosis: Undifferentiated malignant tumor. Comment: the cytologic differential included the metastasis of head/neck-associated carcinoma and Hodgkin's lymphoma due to atypical mononuclear cells in the reactive lymphoid background. Histopathology: the nasopharyngeal biopsy showed undifferentiated nasopharyngeal carcinoma.\nTHM: (1) Metastasis in the LNs in undifferentiated carcinoma of the nasopharynx involves diagnostic challenges during the FNA.[] This condition may be confused with other nonkeratinized carcinoma metastases and lymphomas (especially Hodgkin's lymphoma). (2) Bizarre cells observed in undifferentiated nasopharyngeal carcinoma may resemble atypical mononuclear cells in Hodgkin's lymphoma (Hodgkin cells) and Reed–Sternberg cells [].
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.