{"id":45721,"date":"2025-09-18T14:00:24","date_gmt":"2025-09-18T06:00:24","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=45721"},"modified":"2026-05-14T15:04:13","modified_gmt":"2026-05-14T07:04:13","slug":"ln-3","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/","title":{"rendered":"Mystery cases &#8211; Lymph Node 3"},"content":{"rendered":"\n<h2>\n\t\tLymph Node 3\n\t<\/h2>\n\t<h1>A Neck Swelling<\/h1>\n\t<p><strong>Clinical history<\/strong>: 64 Chinese Male. Smoker.\u00a0Noticed left neck swelling for 1 month.<\/p>\n<p>Physical examination revealed matted left level II &#8211; III cervical lymph nodes<\/p>\n\n\t1. Air-dried smear (Hemacolor)\n\n<iframe loading=\"lazy\" width=\"1050\" height=\"600\" src=\"https:\/\/www.youtube.com\/embed\/Y1oRLH219p8?si=O6qjRmhM5jpcwLOl\" title=\"38M Mediastinal mass core imprint\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n\n\t2. Alcohol-fixed smear (Pap)\n    \n<iframe loading=\"lazy\" width=\"1050\" height=\"600\" src=\"https:\/\/www.youtube.com\/embed\/hOCqVvAbz6g?si=30kzSC22BboiO6Ok\" title=\"38M Mediastinal mass core imprint\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n\n\t<p>1. You&#8217;ve just screened this case. What would you do next?\u00a0<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">Discussion<\/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<p>The smears clearly show a population of malignant cells.<\/p>\n<p>The cytomorphologic features (large atypical cells, macronucleoli, syncytial architecture, relative paucity of lymphoglandular bodies) suggest a non-lymphoid malignancy. \u00a0\u00a0<\/p>\n<p>Hence, a metastatic poorly differentiated \/ undifferentiated carcinoma is high on the list, this being an Asian patient.\u00a0<\/p>\n<p>It would be prudent\u00a0to check the clinical notes to see if the post-nasal space has been examined, and, if so, whether there is an accompanying biopsy. If there is, a morphologic comparison could be made of both samples, as the node likely represents metastatic nasopharyngeal carcinoma.<\/p>\n<p>Any necessary stains can be performed on the biopsy (eg. EBER-ISH).<\/p>\n<p>Each report (cytology and histology) should contain a reference to the other.\u00a0<\/p>\n<ul>\n<li>If there is no accompanying PNS biopsy, then one could see if there is available material from the FNA for a cell block, and perform EBER-ISH on it.\u00a0<\/li>\n<li>If no cell block is available, it should be signed out as metastatic poorly differentiated carcinoma with appropriate comments to direct further investigation \u00a0(see sample diagnosis below).<\/li>\n<\/ul>\n\t<p>\u00a02.\u00a0What is the diagnosis?\u00a0<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">Description and Diagnosis<\/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>\u00a0<\/p>\n<p>Moderately cellular smears show large,\u00a0highly atypical cells occurring both singly and in syncytial sheets.\u00a0The cells contain large, round to ovoid nuclei featuring prominent nucleoli, The nuclei are 3-5 times the diameter of resting lymphocytes. Many of the cells contain delicate ill-defined cytoplasm, and some dispersed cells occur as bare nuclei.\u00a0<\/p>\n<p>A mixed lymphoid population is noted in the background.\u00a0<\/p>\n<p><strong>Diagnosis: Cervical lymph node, FNA: Metastatic poorly differentiated carcinoma.<\/strong><\/p>\n<p>Comments: In this region (South-East Asia), \u00a0nasopharyngeal carcinoma should be excluded. Recommend correlation with relevant clinical investigations, eg. nasoendoscopy.<\/p>\n<p>The cytology demonstration videos can be viewed below.<\/p>\n\tHere is the video demonstration with voiceover.\n    \n<iframe loading=\"lazy\" width=\"1050\" height=\"600\" src=\"https:\/\/www.youtube.com\/embed\/1dxfNHgcYq4?si=YM9mzyvjzKB8_xl8\" title=\"38M Mediastinal mass core imprint\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n\n\n","protected":false},"excerpt":{"rendered":"<p>Lymph Node 3 A Neck Swelling Clinical history: 64 Chinese Male. Smoker.\u00a0Noticed left neck swelling for 1 month. Physical examination revealed matted left level II &#8211; III cervical lymph nodes 1. Air-dried smear (Hemacolor) 2. Alcohol-fixed smear (Pap) 1. You&#8217;ve just screened this case. What would you do next?\u00a0 Discussion Expand &nbsp; The smears clearly [&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-45721","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-3\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"Lymph Node 3 A Neck Swelling Clinical history: 64 Chinese Male. Smoker.\u00a0Noticed left neck swelling for 1 month. Physical examination revealed matted left level II &#8211; III cervical lymph nodes 1. Air-dried smear (Hemacolor) 2. Alcohol-fixed smear (Pap) 1. You&#8217;ve just screened this case. 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