Case 363 -- A male in his late 80s with a left sided neck mass

Contributed by Maurice R. Grant, MD and Fiona Craig, MD
Published on line in September 2003


A male in his late 80s with a past medical history significant for prostatic adenocarcinoma 10 years ago presented with a left sided neck mass. An evaluation by fine needle aspiration was requested. Based on the Diff Quik stain slides (Figures 1, 2 and 3) please answer the following questions:

  1. What is your diagnosis?
  2. Is this a primary or metastatic process (i.e. is this metastatic prostatic adenocarcinoma)?
  3. What do you tell the clinician?

Figure 1 shows is a population of discohesive large cells admixed with smaller more normal appearing lymphocytes. These large cells have increased nuclear to cytoplasmic ratio, hyperchromatic nuclei with prominent nucleoli. Some of the large lymphocytes show irregular nuclear outlines.

Figures 2 show numerous large, abnormal cells with mitotic figures and admixed small normal appearing lymphocytes.

Figures 3 and 4 are H&E stained slides that show similar features as the Diff Quik stained sections. In figure 4, there are occasional cells with eccentrically place and/or "kidney shaped" nuclei.


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