PMC8053476_01
(a) FNA from cervical LN: Tumor cells seen as thick fragments and singly placed cells, intimately admixed with lymphocytes and plasma cells (May-Grunwald Giemsa [MGG], x20). (b) Oval, plump to elongated cells with indistinct outline, moderate pale cytoplasm (Papanicolaou [PAP], x20). (c) Nuclei are round, oval to plump with fine chromatin and prominent nuclear intranuclear inclusion and nuclear grooves (arrow) (Papanicolaou, x40). (d) Vague microfollicular pattern and dissociated tumor cells (PAP, x20).
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F1
The cytological features are better highlighted on May-Grunwald Giemsa (MGG) stain [Figure 1a]. The cells are round to oval, with mild-to-moderate pale wispy cytoplasm; indistinct cell borders [Figure 1b], round to oval to plump nuclei with fine chromatin, prominent nucleoli, and many stripped nuclei. Nuclear grooves and intranuclear inclusions have also been reported [Figure 1c]. The nuclei were hyperchromatic, however, prominent nucleoli were not observed [Figure 1d]. Considering the primary presentation of enlarged neck nodes, USG favoring solitary hypoechoic lesion in thyroid and cytomorphology of vague papillary structures, microfollicular pattern, [Figure 1d] nuclear grooves, and intranuclear inclusions highlighted under MGG stain [Figure 1c]; metastasis of papillary thyroid carcinoma is the most probable diagnosis.
FNA from Para pharyngeal LN mass: Tumor cells with similar morphology with few scattered mature squamous cells (Hematoxylin and eosin, x20).
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F2
FNA from parapharyngeal lymph nodes yielded similar cytomorphological features as that from cervical nodes [Figure 2].
Tonsillar mass Histopathology: Subepithelial tumor consisting of solid islands and fascicles separated by fibrous stroma having mononuclear cell infiltration. Cells are round to oval with moderate pale cytoplasm, central nuclei with vesicular chromatin, and nucleoli in some. Occasional pleomorphic cells also evident (Hematoxylin and eosin, x20).
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F3
The tonsillar biopsy showed subepithelial tumor which composed of solid nests whorls and rare foci with storiform pattern of spindle to oval to plump cells, admixed with lymphoplasmacytic infiltrate [Figure 3].
Immunohistochemistry: Tumor cells expressing strong membranous positivity (CD21, x20).
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F4
The tumor cells expressed CD21 membranous positivity and therefore substantiated the diagnosis of FDC sarcoma [Figure 4].