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.[]
BH: A 6-year-old male had an LN 30 mm in diameter in the right submandibular region and multiple LNs, the largest of which measured 25 mm and 15 mm, in the right cervicojugular region. US findings: Compatible with abscess/necrotic appearance. A US-FNA was performed on the largest LN (3 cm in size) in the right submandibular region. The procedure could not be repeated on the other LNs, as the pediatric patient could not be controlled.\nCytologic findings: Epithelioid histiocytes, epithelioid histiocytic granulomas, and Langhans-type giant cells were observed adjacent to a cell population with a high number of large atypical lymphoid cells []. Cytologic diagnosis: atypical lymphoid proliferation comprising granulomatous structures. Comment: granulomatous structures may be components of granulomatous inflammation (e.g., tuberculosis, sarcoid) or may develop secondarily to a lymphoproliferative lesion or carcinoma metastasis. Histopathology: Burkitt lymphoma with secondary granulomatous inflammatory foci (no information could be obtained regarding the cause of granulomatous inflammation proposed in histopathological diagnosis).\nTHM: (1) In the absence of typical cytological components of granulomatous inflammation, individually or sporadically represented epithelioid histiocytes and granuloma-like structures are not sufficient for the diagnosis of “granulomatous inflammation.” (2) In such cases, it would be more appropriate to write “granulomatous reaction” and add a remark in a similar context like our above-mentioned comment. (3) Granulomatous reactions and granulomas are not usually expected to accompany non-Hodgkin's lymphoma; they mostly accompany Hodgkin's lymphoma.[]