Brief history (BH): a 43-year-old female presented with a palpable mass in the right neck. US revealed a 20 mm × 15 mm hypoechogenic lymph node (LN) in the right cervical jugular region. During US-FNA, 3 cc of hemorrhagic cystic fluid was obtained. It was believed that the cystic LN could be associated with papillary thyroid carcinoma. US was performed on the thyroid, which had not previously undergone US. The radiologist detected an 8 mm × 6 mm microcalcified nodule in the right lobe. FNA was also performed on this nodule.\nCytologic findings: (i) LN: smears from cystic fluid showed clusters of atypical thyroid follicular cells on a cystic background with hemosiderin-laden macrophages. (ii) Thyroid nodule: the hypercellular samples revealed atypical papillary clusters with occasional intranuclear vacuoles and grooves []. Cytologic diagnosis: LN: Metastasis of cystic papillary thyroid carcinoma. Right thyroid nodule: Thyroid papillary carcinoma. The cytologic diagnosis was confirmed histopathologically.\nTHMs: After the fluid was obtained from the LN during the FNA, “metastasis of thyroid papillary carcinoma,” which comes to mind first in the differential diagnosis of lesions that form cystic degenerations at the LN, was considered.[] Other lesions included in the differential diagnosis were hemangioma, metastasis from malignity in the salivary gland, squamous cell carcinoma, and malignant melanoma.[]
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.