PMC3420732_01
Ultrasound image at the time of core needle biopsy shows a well-circumscribed, 1.7 x 1.5 x 1.4 cm mass in the left axilla.
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fig1
The mass measured 1.7 x 1.5 x 1.4 cm by ultrasound (Figure 1).
Intraoperative touch preparation slide exhibits single and clusters of atypical epithelioid cells with prominent nucleoli and focal mitotic figures (wide short arrow). The slide also shows keratin debris (narrow long arrow), numerous neutrophils, and occasional multinucleated foreign-body-type giant cells (insert). Hematoxylin and eosin stain; magnification: x400.
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fig2
A touch preparation slide was made and showed numerous single and sheets of atypical epithelioid cells with enlarged nuclei, prominent nucleoli, and focal mitotic figures, suggesting a carcinoma (Figure 2).
Low power view of permanent section shows a squamous inclusion cyst within a lymph node. Hematoxylin and eosin stain; magnification: x40.
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fig3
By microscopic examination, the cavity corresponded to a squamous inclusion cyst within a lymph node (Figure 3).
Parts of the cyst are lined by stratified squamous epithelial cells with thick laminated hyperkeratotic material. Hematoxylin and eosin stain; magnification: x400.
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fig4
Parts of the cyst were lined by stratified squamous epithelial cells with a prominent granular cell layer and thick laminated hyperkeratotic material (Figure 4).
Some parts of the cyst are lined by multiple layers of polygonal squamous cells without a granular cell layer or hyperkeratosis. Hematoxylin and eosin stain; magnification: x400.
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fig5
Other parts were lined by multiple layers of polygonal squamous cells without granular cells or hyperkeratosis (Figure 5).
In the parts of the cyst showing multiple polygonal squamous cells without a granular cell layer or hyperkeratosis, the inner cyst cells are immunopositive for carcinoembryonic antigen. Immunostain; magnification: x400.
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fig6
The inner cyst surface in these latter parts showed immunopositivity for carcinoembryonic antigen (Figure 6) and Cam 5.2, suggesting a glandular origin of the cyst with extensive squamous metaplasia.
Surrounding the cyst is abundant keratin debris (arrow) admixed with histiocytic and lymphocytic inflammation. Hematoxylin and eosin stain; magnification: x400.
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fig7
The surrounding tissue exhibited abundant keratin debris admixed with aggregates of histiocytes, foreign body type multinucleated giant cells, abscess formation, and fat necrosis, indicating cyst rupture with extensive reaction (Figure 7).