CytoPage Quiz – 2026 Feb – NUS Pathweb

Question: An enlarged lymph node

A 67-year-old man presents with an enlarged left level 2 cervical lymph node. Ultrasound-guided FNA of the cervical lymph node is performed. Representative images from the smears are shown below.

No material is available for ancillary testing. Which of the following options reflects the most appropriate diagnostic category and management recommendation for this case, according to the WHO Reporting System for Lymph Node Cytopathology?

(A) Benign; Material sampled may not correlate with the clinical findings, recommend repeat FNA with ROSE and ancillary testing

(B) Benign; Recommend correlation with microbiological investigations

(C) Atypical; Recommend repeat clinical and imaging examination

(D) Suspicious for malignancy; Recommend repeat FNA with flow cytometry

(E) Malignant; Recommend core biopsy

Figure 1: Hemacolor 10x

Figure 2: Hemacolor 20x

Figure 3: Pap 20x

Figure 4: Pap 40x

Quiz written by Dr Darren Chua, National University Hospital

Answer

Answer: (E) Malignant; Recommend core biopsy

Explanation: The smears show cohesive sheets of epithelial cells with enlarged ovoid nuclei, prominent nucleoli, and limited to moderate amounts of cytoplasm. The findings most likely represent a metastatic carcinoma. Therefore, options (A) and (B) are not appropriate as this is not a benign finding. Both the diagnostic category and recommendation in option (C) to repeat the clinical and imaging examination are also not appropriate.

As no material for ancillary testing is available, a repeat procedure to obtain additional material for further workup will likely be necessary. However, given that this most likely represents a metastatic carcinoma rather than lymphoma, the recommendation in option (D) to repeat the FNA with flow cytometry is not appropriate.

Follow up revealed this to be metastatic undifferentiated nasopharyngeal carcinoma.

CytoPage Quiz 2026 February