BH: an FNA was requested for a 45-year-old female patient with multiple sclerosis due to the presence of an LN in the neck. Multiple LNs, the largest of which was 3 cm, were detected during the US. A US-FNA was performed on the dominant LN located in the left cervical region. Cytologic findings: homogenously spread monomorphic, large, round, atypical lymphoid cells were detected []. Cytologic diagnosis: Non-Hodgkin's lymphoma. Surgical biopsy and afterward: The biopsy from the neck was reported to be a “sebaceous cyst.” I wrote a letter to her physician and emphasized that there were bilateral multiple LNs in the neck and that the FNA picture did not reflect a “sebaceous cyst” at all. I called the patient 5 months later. After receiving my note, her physician excised the LN on which I had performed the FNA. The patient was diagnosed with “diffuse large B-cell lymphoma” and received treatment. It turned out that the mass described as a “sebaceous cyst” was removed by the physician, as it was easy to remove from the surface of the opposite side of the LNs that underwent FNA!
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.[]