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 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.”