{"id":44681,"date":"2025-08-05T13:20:11","date_gmt":"2025-08-05T05:20:11","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=44681"},"modified":"2025-08-05T13:20:11","modified_gmt":"2025-08-05T05:20:11","slug":"ln-2","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-2\/","title":{"rendered":"Mystery cases &#8211; Lymph Node 2"},"content":{"rendered":"\n<h2>\n\t\tLymph node case 2\n\t<\/h2>\n\t<h1>Another cervical lymph node<\/h1>\n\t<p><strong>Clinical history:<\/strong> A 71 year old male presented with an enlarged cervical lymph node and weight loss of 5kg.\u00a0<\/p>\n<p>A fine needle aspiration of the lymph node was performed.<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/LN17.jpeg\" alt=\"Lymph node case 2\" itemprop=\"image\" height=\"1440\" width=\"1920\" title=\"LN17\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/LN18.jpeg\" alt=\"LN18\" itemprop=\"image\" height=\"1440\" width=\"1920\" title=\"LN18\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">Cytologic findings<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\n<img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/LN19.jpeg\" alt=\"\" \/>\n<ul>\n<li>Crowded sheets of tumour cells with overlapping nuclei<\/li>\n<li>Acinar formation is discernible within the sheets<\/li>\n<li>Round to oval eccentric nuclei with mild nuclear pleomorphism<\/li>\n<li>Fine powdery chromatin and inconspicuous nucleoli<\/li>\n<li>Moderate to abundant pale cytoplasm<\/li>\n<li>Clean background &#8211; no necrosis<\/li>\n<\/ul>\n<p>Commentary:<\/p>\n<p>Provisionally, the diagnosis is metastatic adenocarcinoma. Given the clinical history of an elderly male, primary sites to consider include lung, upper gastrointestinal tract, pancreatobiliary system, lower gastrointestinal tract and prostate.<\/p>\n<p>There are some morphologic clues to the site of origin, can you identify them?<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-1\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-1\">Cell block morphology<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-1\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\n<img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/LN20.jpeg\" alt=\"\" \/>\n<ul>\n<li>Tumour fragments with prominent acinar formation<\/li>\n<li>Round to oval nuclei with slightly irregular nuclear contours<\/li>\n<li>Relatively\u00a0 fine chromatin with discernible small nucleoli<\/li>\n<li>Moderate amounts of amphophilic cytoplasm<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-2\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-2\">Immunohistochemistry<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-2\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/LN21.jpeg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/LN22.jpeg\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li>Diffuse positivity for PSA and NKX3.1 confirms the diagnosis of metastatic prostatic adenocarcinoma<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-3\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-3\">Diagnosis and take home points<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-3\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\n<strong>Diagnosis<\/strong>\n<ul>\n<li>Metastatic adenocarcinoma of prostate origin.<\/li>\n<\/ul>\n<p><strong>Take home points<\/strong><\/p>\n<ul>\n<li>Prostatic adenocarcinoma is one of the most common cancers in men<\/li>\n<li>Prostatic adenocarcinoma was commonly reported as a &#8220;cancer of unknown primary&#8221; in older publications<\/li>\n<li>Maintain a high index of suspicion if a well differentiated adenocarcinoma presents at a metastatic site in an elderly male<\/li>\n<li>The morphologic clues on cytology include tight acinar formation and mild nuclear pleomorphism<\/li>\n<li>The diagnosis is not difficult if cell block, immunohistochemistry or concurrent biopsy are available; as well as a history of known prostatic carcinom<\/li>\n<\/ul>\n\t<p><em>Case writer: Dr Noel Chia<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>Lymph node case 2 Another cervical lymph node Clinical history: A 71 year old male presented with an enlarged cervical lymph node and weight loss of 5kg.\u00a0 A fine needle aspiration of the lymph node was performed. Cytologic findings Expand &nbsp; Crowded sheets of tumour cells with overlapping nuclei Acinar formation is discernible within the [&hellip;]<\/p>\n","protected":false},"author":828,"featured_media":0,"parent":44933,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-44681","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NUS Pathweb<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"Lymph node case 2 Another cervical lymph node Clinical history: A 71 year old male presented with an enlarged cervical lymph node and weight loss of 5kg.\u00a0 A fine needle aspiration of the lymph node was performed. 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