{"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":"2025-09-18T14:01:08","modified_gmt":"2025-09-18T06:01:08","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":"\r\n<h2>Lymph Node 3<\/h2>\r\n<h1>A Neck Swelling<\/h1>\r\n<p><strong>Clinical history<\/strong>: 64 Chinese Male. Smoker.\u00a0Noticed left neck swelling for 1 month.<\/p>\r\n<p>Physical examination revealed matted left level II &#8211; III cervical lymph nodes<\/p>\r\n<p>1. Air-dried smear (Hemacolor) <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=\"allowfullscreen\"><\/iframe> 2. Alcohol-fixed smear (Pap) <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=\"allowfullscreen\"><\/iframe><\/p>\r\n<p>1. You&#8217;ve just screened this case. What would you do next?\u00a0<\/p>\r\n<p><a href=\"#\" id=\"fl-accordion--label-0\" aria-controls=\"fl-accordion--panel-0\" tabindex=\"0\">Discussion<\/a> <a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a><\/p>\r\n<p>&nbsp;<\/p>\r\n<p>The smears clearly show a population of malignant cells.<\/p>\r\n<p>The cytomorphologic features (large atypical cells, macronucleoli, syncytial architecture, relative paucity of lymphoglandular bodies) suggest a non-lymphoid malignancy. \u00a0\u00a0<\/p>\r\n<p>Hence, a metastatic poorly differentiated \/ undifferentiated carcinoma is high on the list, this being an Asian patient.\u00a0<\/p>\r\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>\r\n<p>Any necessary stains can be performed on the biopsy (eg. EBER-ISH).<\/p>\r\n<p>Each report (cytology and histology) should contain a reference to the other.\u00a0<\/p>\r\n<ul>\r\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>\r\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>\r\n<\/ul>\r\n<p>\u00a02.\u00a0What is the diagnosis?\u00a0<\/p>\r\n<p><a href=\"#\" id=\"fl-accordion--label-0\" aria-controls=\"fl-accordion--panel-0\" tabindex=\"0\">Description and Diagnosis<\/a> <a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a><\/p>\r\n<p>&nbsp;<\/p>\r\n<p>Highly\u00a0cellular smears show numerous moderately sized 3 dimensional clusters of atypical cells. The clusters exhibit scalloped borders. The cells contain moderately pleomorphic nuclei with relatively smooth nuclear membranes, prominent nucleoli and raise N\/C ratios. The cytoplasm varies from fairly pale to dense, and in some areas, exhibits a two-toned appearance with a finely bubbly outer edge. The nuclei are fairly centrally located within the cells. Some cell-in-cell arrangements are noted. Windows are not readily identified. No definite population of benign mesothelial cells is seen.<\/p>\r\n<p><strong>Diagnosis: Left pleural effusion: Malignant mesothelioma\u00a0<\/strong><\/p>\r\n<p>Note: Being a relatively uncommon diagnosis in most areas, the first time diagnosis of malignant mesothelioma should be made in the context of clinicopathologic correlation (history, imaging) and with immunocytochemical corroboration.\u00a0<\/p>\r\n<p>Here is the video demonstration with voiceover. <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=\"allowfullscreen\"><\/iframe><\/p>\r\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. What would you do next?\u00a0 Discussion Expand &nbsp; The smears clearly [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/\" \/>\n<meta property=\"og:site_name\" content=\"NUS Pathweb\" \/>\n<meta property=\"article:modified_time\" content=\"2025-09-18T06:01:08+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/\",\"name\":\"\",\"isPartOf\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#website\"},\"datePublished\":\"2025-09-18T06:00:24+00:00\",\"dateModified\":\"2025-09-18T06:01:08+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Cytopathology\",\"item\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Cytopathology Mystery Cases\",\"item\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/\"},{\"@type\":\"ListItem\",\"position\":4,\"name\":\"Mystery cases &#8211; Lymph Node 3\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#website\",\"url\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/\",\"name\":\"NUS Pathweb\",\"description\":\"Pathology made easy\",\"publisher\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#organization\",\"name\":\"NUS Medicine PathWeb\",\"url\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2020\/08\/NUS-Medicine-Logo.png\",\"contentUrl\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2020\/08\/NUS-Medicine-Logo.png\",\"width\":300,\"height\":61,\"caption\":\"NUS Medicine PathWeb\"},\"image\":{\"@id\":\"https:\/\/medicine.nus.edu.sg\/pathweb\/#\/schema\/logo\/image\/\"},\"sameAs\":[\"https:\/\/www.instagram.com\/pathweb\/\",\"https:\/\/www.youtube.com\/channel\/UC3FweZwONWAicB72vF9P5ew\/playlists\"]}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"NUS Pathweb","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/","og_locale":"en_US","og_type":"article","og_description":"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;]","og_url":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/","og_site_name":"NUS Pathweb","article_modified_time":"2025-09-18T06:01:08+00:00","twitter_card":"summary_large_image","twitter_misc":{"Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/","url":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/","name":"","isPartOf":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#website"},"datePublished":"2025-09-18T06:00:24+00:00","dateModified":"2025-09-18T06:01:08+00:00","breadcrumb":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/ln-3\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/medicine.nus.edu.sg\/pathweb\/"},{"@type":"ListItem","position":2,"name":"Cytopathology","item":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/"},{"@type":"ListItem","position":3,"name":"Cytopathology Mystery Cases","item":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/"},{"@type":"ListItem","position":4,"name":"Mystery cases &#8211; Lymph Node 3"}]},{"@type":"WebSite","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#website","url":"https:\/\/medicine.nus.edu.sg\/pathweb\/","name":"NUS Pathweb","description":"Pathology made easy","publisher":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/medicine.nus.edu.sg\/pathweb\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#organization","name":"NUS Medicine PathWeb","url":"https:\/\/medicine.nus.edu.sg\/pathweb\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#\/schema\/logo\/image\/","url":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2020\/08\/NUS-Medicine-Logo.png","contentUrl":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2020\/08\/NUS-Medicine-Logo.png","width":300,"height":61,"caption":"NUS Medicine PathWeb"},"image":{"@id":"https:\/\/medicine.nus.edu.sg\/pathweb\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.instagram.com\/pathweb\/","https:\/\/www.youtube.com\/channel\/UC3FweZwONWAicB72vF9P5ew\/playlists"]}]}},"_links":{"self":[{"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages\/45721"}],"collection":[{"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/users\/828"}],"replies":[{"embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/comments?post=45721"}],"version-history":[{"count":3,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages\/45721\/revisions"}],"predecessor-version":[{"id":45725,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages\/45721\/revisions\/45725"}],"up":[{"embeddable":true,"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/pages\/44933"}],"wp:attachment":[{"href":"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-json\/wp\/v2\/media?parent=45721"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}