{"id":44958,"date":"2025-08-05T14:03:40","date_gmt":"2025-08-05T06:03:40","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=44958"},"modified":"2025-08-05T16:01:55","modified_gmt":"2025-08-05T08:01:55","slug":"hn-2","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/hn-2\/","title":{"rendered":"Mystery cases &#8211; Head &#038; Neck NOS 2"},"content":{"rendered":"\n<h2>\n\t\tHead and Neck NOS case 2\n\t<\/h2>\n\t<h1>A spindly neck lump<\/h1>\n\t<p><strong>Clinical history<\/strong>: A 40-year-old lady presented with a 2-month history of an enlarging right posterior neck lump. Clinical impression was that of cervical lymphadenopathy and fine needle aspiration of the lump 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\/HN3.jpg\" alt=\"Head and Neck NOS case 2\" itemprop=\"image\" height=\"768\" width=\"768\" title=\"HN3\" 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\/HN4.jpg\" alt=\"HN4\" itemprop=\"image\" height=\"768\" width=\"768\" title=\"HN4\" 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<p>&nbsp;<\/p>\n<ul>\n<li>Loose sheets of ovoid to plump spindle cells associated with some myxoid to fibrillary stroma<\/li>\n<li>Singly-occurring plump to stellate cells with tapering cytoplasmic processes and some plasmacytoid cells<\/li>\n<li>Scattered lymphocytes and occasional osteoclast-like multinucleated giant cells also noted<\/li>\n<li>No necrosis present<\/li>\n \t&nbsp;<br \/>\n<img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/HN5.jpg\" alt=\"\" \/>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-1\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-1\">Further investigations and differential diagnoses<\/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<strong>Further investigations:\u00a0<\/strong>Ultrasound scan showed a well-defined heterogeneous hypoechoic nodule within the subcutaneous layer measuring 1.0 x 0.9 x 0.8 cm. No fatty hilum suggestive of a normal lymph node was seen. No invasion of underlying structures was present.\n<p><strong>Differential diagnoses:<\/strong><\/p>\n<ul>\n<li>Mesenchymal lesions\/neoplasms\n<ul>\n<li>Nodular fasciitis\n<ul>\n<li>Spindle to stellate cells occurring in clusters and as singly dispersed cells; can be associated with mxyoid stroma<\/li>\n<li>Cells have abundant cytoplasm and tapering cytoplasmic processes<\/li>\n<li>Inflammatory cells often seen<\/li>\n<li>Can have relatively frequent\u00a0mitoses<\/li>\n<li>If cell block is available &#8211; lesional cells are positive for SMA<\/li>\n<\/ul>\n<\/li>\n<li>Schwannoma\n<ul>\n<li>Clusters of slender spindle cells associated with fibrillary stroma<\/li>\n<li>Nuclei may appear wavy<\/li>\n<li>Nuclear palisading may be seen<\/li>\n<li>Generally lack single cells in the background<\/li>\n<li>Occasional larger, atypical nuclei (so-called ancient change) may be present<\/li>\n<li>If cell block is available &#8211; lesional cells are positive for S100<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Epithelial neoplasms\n<ul>\n<li>Pleomorphic adenoma\n<ul>\n<li>Potential differential diagnosis if suitable location (e.g. angle of jaw, submandibular region etc)<\/li>\n<li>Clusters of epithelioid to spindle epithelial cells blending into metachromatic fibrillary stroma<\/li>\n<li>Scattered singly dispersed plasmacytoid to plump cells in the background<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-2\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-2\">Histologic findings<\/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&nbsp;<br \/>\nThe lump was excised a few months later.\u00a0\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/HN6.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/HN7.jpg\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/HN8.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/HN9.jpg\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<ul>\n<li>Circumscribed subcutaneous nodule composed of a cellular proliferation of spindle cells in a fascicular to storiform pattern with areas of microcystic change; myxoid and oedematous areas<\/li>\n<li>Tissue culture-like arrangement of cells seen at the periphery<\/li>\n<li>Admixed lymphocytes, osteoclast-like multinucleated giant cells and extravasated red blood cells<\/li>\n<li>Scattered mitoses seen, but no atypical forms identified<\/li>\n<li>No necrosis seen<\/li>\n<li>Spindle cells are positive for SMA, and negative for S100, CD34, desmin and beta-catenin<\/li>\n<\/ul>\n<table>\n\n<\/table>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-3\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-3\">Diagnosis<\/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>Nodular fasciitis<\/strong>\n<p><strong>Comments:<\/strong><\/p>\n<ul>\n<li>The supportive clinical features in this case include &#8211; rapid growth over a relatively short period of time and subcutaneous location of the lesion. Sometimes, there can be a preceding history of trauma to the area.<\/li>\n<li>Nodular fasciitis is known mimic of malignancy on both cytology and histology &#8211; awareness of its typical features and correlation with clinical information are crucial.<\/li>\n<\/ul>\n\t<p><em>Case writer: Dr Hui Min Tan<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>Head and Neck NOS case 2 A spindly neck lump Clinical history: A 40-year-old lady presented with a 2-month history of an enlarging right posterior neck lump. Clinical impression was that of cervical lymphadenopathy and fine needle aspiration of the lump was performed. Cytologic findings Expand &nbsp; Loose sheets of ovoid to plump spindle cells [&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-44958","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\/hn-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"Head and Neck NOS case 2 A spindly neck lump Clinical history: A 40-year-old lady presented with a 2-month history of an enlarging right posterior neck lump. 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