Cribriform adenocarcinoma of minor salivary gland: A report of two cases with an emphasis on cytology

Cribriform adenocarcinoma of minor salivary gland (CAMSG) is a recently characterized low grade salivary gland malignancy that most commonly presents as a mass in the base of the tongue, frequently with regional lymph node metastasis. Given its relative rarity and overlapping cytomorphology, CAMSG may be confused with polymorphous low grade adenocarcinoma (PLGA) in minor salivary gland sites and papillary thyroid carcinoma (PTC) in cervical metastasis, in both fine‐needle aspiration and excisional specimens. As there are no cytology reports in the literature, we present two new cases of CAMSG and describe the aspiration cytology of the tumor taken from bench top aspirates, compare it with the histomorphology, and discuss the features that may help one avoid misdiagnosis of PTC in the setting of cervical lymph node metastasis. We found that like PTC, aspirates of CAMSG contain polymorphic fragments of epithelial cells arranged in monolayer sheets, papillary fronds and tips, and occasional cribriform configurations, and metachromatic stromal fragments, which may be misinterpreted as colloid. A background of myxoid/mucoid material also reminiscent of colloid was prominent. Differentiation from PLGA is more difficult based strictly on cytology. A review of the most current literature in relation to the molecular and immunohistochemical profiles, therapeutic options, and prognosis is also presented. It is critical for pathologists and clinicians to be aware of this tumor when presented with patients having a cervical lymph node mass in the absence of a primary tumor. Diagn. Cytopathol. 2014;42:1085–1090. © 2014 Wiley Periodicals, Inc.     

Detection of bartonella henselae DNA by polymerase chain reaction in a patient with cat scratch disease: a case report

We report a case of cat scratch disease caused by Bartonella henselae in Korea. A 25-yr-old woman developed left cervical lymphadenopathy with history of contact with a dog. The cervical lymphadenopathy persisted for 1 month and resolved gradually and spontaneously. Serologic test was not done during the acute stage of the disease. Immunofluorescent antibody test performed during the convalescent stage was positive for B. henselae. To confirm B. henselae infection, polymerase chain reaction (PCR) analysis using aspirates of cervical lymph node was performed and the presence of B. henselae DNA was demonstrated. This is the first reported case of cat scratch disease in Korea confirmed by PCR for B. henselae DNA.     

Cytologic diagnosis of “CASTLE” of thyroid gland: Report of a case with histologic correlation

We report on the cytologic and histologic features of a rare form of lymphoepithelioma-like carcinoma of the thyroid, i.e., carcinoma showing thymus-like element (CASTLE). Sixteen cases of cervical lymph node aspirates with metastatic nasopharyngeal carcinoma are also reviewed. While it is important to recognize CASTLE of the thyroid because of its distinctly good prognosis, its cytologic features closely resemble those in metastatic nasopharyngeal carcinoma. Diagn Cytopathol 1996;15:224–227. © 1996 Wiley-Liss, Inc.     

Benign stromal fragments in metastases of squamous cell carcinoma in cytology--a report of two cases

Benign stromal fragments or extracellular matrix can be seen in aspirates of invasive carcinomas. Although well documented on histology, this feature is rarely observed on fine needle aspirates and can create diagnostic difficulties on smears. Only three such cases have been reported so far. We report two more cases where stromal fragments were seen in association with invasive squamous cell carcinoma (SCC). Two cases of biopsy proved invasive SCC of the cheek and of the larynx presented with metastases to the submandibular salivary gland and to the cervical lymph node respectively. Aspirates of the metastatic sites showed two components: one of SCC and the other benign stroma, both in close approximation with one another. Both patients were treated with radiotherapy. Biopsy of the metastatic sites was not done. Benign stromal fragments can be encountered in aspirates of invasive carcinoma. These may be cellular or myxoid. Since such stromal fragments can also be seen in salivary tumours, adnexal tumours, fibroadenoma and phylloides tumour, their presence should be interpreted in the light of clinical findings of the patient, so that an erroneous diagnosis can be avoided.     

Fine-needle aspiration of lymphadenopathy of suspected infectious etiology

We present a protocol for culture of lymph node find-needle aspirations in a series of 44 patients. Clinical indications for inclusion in the protocol included fever, localized erythema, pain or heat, an independent clinical diagnosis of infection by the referring physician, or a grossly purulent appearance of the initial aspirate material. Organisms (fungi, bacteria, or mycobacteria) were isolated in 13 (30%) of the aspirates. The probable contamination rate was 9%. These figures approached the culture yields obtained from open biopsy specimens as reported in the literature. A notable discrepancy existed between the cytologic appearance of the aspirates and culture results in three cases of mycobacteria. Six unsuspected malignancies were diagnosed. There were no complications from the procedure in this series. Based on this study, we present recommendations for culture of fine-needle aspirates from lymph nodes.     

Metastatic nasopharyngeal carcinoma: cytologic features of 18 cases.

The cytologic features of 18 fine-needle aspirates (FNAs) of metastatic nasopharyngeal carcinoma from 17 patients were examined. The 12 males and 5 females had a median age of 45 years (range 17-75 years). Six were white, five Oriental, four Hispanic, and two black. All patients had mid- or upper-cervical lymphadenopathy (14 bilateral, 3 unilateral). Seven developed widespread metastasis (bone, 5; lung, 2; liver 1; adrenal, 1; soft tissue, 1). The FNAs were from cervical lymph nodes (15), liver (1), adrenal (1), and soft tissue (1). Most aspirates showed similar cytologic features. Tumor cells were present singly and in syncytial groups with overlapping moderately pleomorphic oval to spindle-shaped nuclei with thin, slightly irregular nuclear contours, moderately hyperchromatic chromatin, and usually one or two prominent nucleoli. The cytoplasm was scant and pale with ill-defined borders. Mitoses were frequent. Mature lymphocytes were common in the background of lymph node aspirates. Electron microscopy and immunocytochemistry confirmed the epithelial nature of the tumor in four cases. Although the cytologic features of metastatic nasopharyngeal carcinoma (NPC) are characteristic, other poorly differentiated neoplasms need to be considered. Clinical and radiologic data are helpful in supporting the cytologic diagnosis.     

Use of PCR for Diagnosis of Post-Kala-Azar Dermal Leishmaniasis

Microscopy and PCR were compared for use in the diagnosis of post-kala-azar dermal leishmaniasis (PKDL) in 63 patients. Aspirates of lymph nodes (samples from 52 patients), skin (23 samples), and bone marrow (18 samples) were used. For 11 patients lymph node aspiration could be repeated 6 months after they recovered from PKDL. During active PKDL, PCR was positive for 42 of 52 (80.8%) lymph node aspirates and 19 of 23 (82.7%) skin aspirates, whereas microscopy was positive for only 9 of 52 (17.3%) lymph node aspirates and 7 of 23 (30.4%) skin aspirates. PCR was always positive when parasites were seen by microscopy. When the results obtained with lymph node and skin aspirates from the same patient (n = 16) were compared, there was complete agreement. Bone marrow samples were negative by microscopy and PCR for 16 patients and positive by both methods for 1 patient; for one sample only the PCR was positive. PCR confirmed the co-occurrence of visceral leishmaniasis and PKDL in one patient and confirmed the suspicion of this co-occurrence in the other patient. After recovery, no parasites were found by microscopy, but 2 of 11 (18.2%) samples were still positive by PCR. Thirty negative controls were all found to be PCR negative, and 15 positive controls were all PCR positive. Cross-reactions with Mycobacterium leprae could be ruled out. In conclusion, PCR with inguinal lymph node or skin aspirates is suitable for confirming the clinical diagnosis of PKDL. In some patients, lymph node aspirates are probably preferred because aspiration of material from the skin may leave scars.     

Detection of Leishmania infantum in Dogs by PCR with Lymph Node Aspirates and Blood

The PCR technique was applied to the diagnosis of leishmaniasis in dogs, both serologically negative and positive. DNA was taken from lymph node aspirates and blood. The primers 13a and 13b, derived from Leishmania amazonies and Leishmania braziliensis kinetoplast DNA (kDNA), also amplified Leishmania infantum IPT1 constant region of minicircle kDNA. The amplified fragment is 116 bp long. It was cloned and the sequence was determined. A 70-bp inner fragment was designed and used as a probe in dot blot hybridization. A group of 124 dogs was examined, 37 of which showed typical symptoms of disease. PCR was performed on 124 blood samples and 52 lymph node aspirates. Using microscopic examination as the "gold standard," we calculated sensitivity, specificity, and positive and negative predictive values of 100% using lymph node aspirates and values of 85, 80, 95, and 57%, respectively, using blood samples. We found that 40% of the animals without lesions and 38% of the animals with clinical signs gave false-negative results by indirect immunofluorescence antibody testing. These animals could contribute to the spreading of infection among dogs, and represent a potential risk for human health as well.     

Evaluation of PCR for diagnosis of visceral leishmaniasis.

An evaluation of Leishmania PCR was performed with bone marrow, lymph node, and blood samples from 492 patients, 60 positive controls, and 90 negative controls. Results were compared with microscopy results for Giemsa-stained smears. PCR and microscopy of lymph node and bone marrow aspirates from patients with microscopically confirmed visceral leishmaniasis (VL) were equally sensitive. However, in patients clinically suspected of having VL and in whom parasites could not be demonstrated by microscopy, PCR was positive for 12 of 23 (52.2%) lymph node aspirates and 8 of 12 (66.7%) bone marrow aspirates, thus confirming the clinical diagnosis of VL. With PCR on filter paper, Leishmania DNA was detected in the blood of 33 of 47 (70%) patients with confirmed VL and in 2 of 11 (19%) patients suspected of having VL. Positive PCR results were more frequently found for blood samples on filter paper than for samples stored in EDTA. In conclusion, PCR is a more sensitive method than microscopy for the detection of Leishmania in lymph node and bone marrow aspirates, being especially useful for the confirmation of cases of suspected VL. Blood from a finger prick may be used for the initial PCR screening of people suspected of having VL. If the PCR of blood is negative, one should perform PCR with lymph node and/or bone marrow material, because PCR with these materials is more often positive.     

Non-cultural detection of Neisseria gonorrhoeae in cervical and vaginal washings

Genetic transformation, an indirect sandwich enzyme-linked immunosorbent assay (ELISA) and the Limulus amoebocyte assay were used to indicate the presence of products of Neisseria gonorrhoeae in vaginal and uterine cervical aspirates from 37 women attending a Department of Genito-Urinary Medicine. In parallel with these tests, qualitative and quantitative assessments of the microbial content of aspirates were made. There was wide variation in the numbers of gonococci cultured. The mean viable count for cervical aspirates was 1 x 10(6) cfu/ml and the range was (5 x 10(3))-(8 x 10(6)) cfu/ml; the mean count for vaginal aspirates was 8.4 x 10(4) cfu/ml and the range (1 x 10(2))-(1 x 10(6)) cfu/ml. Viable counts of organisms other than gonococci in vaginal aspirates were two to tenfold greater than the corresponding counts for cervical aspirates. Of 20 patients with gonorrhoea confirmed by conventional diagnostic cultures, aspirates from 15 (75%) gave a positive transformation result, and 12 (60%) a positive ELISA result; 16 (84.2%) out of 19 of these aspirates tested by the Limulus lysate assay were positive at a dilution of 1 in 100.     

Fine-needle aspiration cytology of extramedullary hematopoiesis (myeloid metaplasia)

Myeloproliferative disease may be associated with extramedullary hematopoiesis (EH). Clinically, however, the differential diagnosis of solid masses in these patients includes not only EH but also inflammatory lesions and malignant neoplasms, including granulocytic sarcoma. We report the fine-needle aspiration (FNA) cytology of extramedullary hematopoiesis in five patients with a history of myeloproliferative disease. All of the masses developed subsequent to the diagnosis of myeloproliferative disease. Two of the patients had chronic myelogenous leukemia, one had essential thrombocythemia, and two had an unspecified chronic myeloproliferative disorder. The patients ranged in age from 50 to 88 years, and all presented with solid masses involving the kidney (two aspirates), liver (one aspirate), and lymph nodes (three aspirates). One of the lymph node aspirates was from a paratracheal lymph node. Cytologically, the lesions were composed of varying numbers of hematopoietic cells from all three hematologic cell lines. The Diff-Quik stain was especially helpful in the recognition of the hematopoietic cells such as granulocytic precursors, eosinophils, and megakaryocytes. In several cases, the megakaryocytic component was particularly prominent. In one case, the Factor VIII immunoperoxidase stain was used to confirm the megakaryocytic lineage of the multinucleated cells. The cytologic differential diagnosis, which includes granulocytic sarcoma, inflammatory disorders, and other lesions containing multinucleated giant cells, is discussed.     

Application of fine needle aspiration biopsy to pediatrics

Fine needle aspiration (FNA) biopsy cytology is a technique rarely used in children, although it is increasingly used in a routine fashion for the evaluation of masses in adults. We reviewed our experience with FNA in patients 16 years of age and younger from the period 1973 to 1987. FNA diagnoses were confirmed either by subsequent surgical biopsy, autopsy, or clinical follow-up for a minimum period of 1 year. One-hundred twelve FNA procedures were performed in 107 patients. Patient age distribution was as follows: newborn to 5 years of age, 37 aspirates; 6 to 11 years of age, 39 aspirates; and 12 to 16 years of age, 36 aspirates. Fifty-five patients were female. Of the 112 aspirates, 70 were diagnosed as benign disorders, 39 were diagnosed as malignant, one was diagnosed as unsatisfactory, and two were considered suspicious for malignancy. The most common sites of involvement for benign lesions were lymph node (31 sites), soft tissue (13 sites), and thyroid (12 sites). The most common sites for malignancies were lymph node (12 sites), bone (eight sites), and soft tissue (eight sites). Of the malignant aspirates, 20 were from primary neoplasms, three were from locally recurrent neoplasms, and 16 were from metastatic neoplasms. Two false-positive and one false-negative diagnoses yielded sensitivity and specificity rates of 97%, and a predictive value of a positive FNA of 95%. Our experience indicates that selective application of FNA is a useful and important step in the evaluation and management of mass lesions throughout the entire age range of infancy and childhood.     

Fine-needle aspiration in the management of peripheral lymphadenopathy in a developing country.

Fine-needle aspiration (FNA) is a simple, cheap, and well-tolerated procedure that is well-established as a method of definitive diagnosis of palpable masses. This review reports the role of FNA in the investigation of peripheral lymphadenopathy as an alternative to expensive surgical excision biopsy in developing countries, where there are limited funds and facilities. All lymph node aspirates done in the FNA clinic at the Department of Pathology, University College Hospital, Ibadan, between 1995-1997 were reviewed. The aspirates were obtained using 21- or 22-gauge needle with a 5- or 10-ml disposable plastic syringe, smeared on standard microscopic slides and stained with Giemsa and/or Papanicolou stains. The most common diagnosis was reactive change/nonspecific inflammation, constituting 33.4%; tuberculosis and metastatic lesions made up 25. 7% and 22.4%, respectively, while lymphoma constituted 16.9% of cases. The commonly aspirated nodes were cervical. Tuberculosis was the most frequent diagnosis in these nodes and was the most commonly diagnosed infective condition, particularly in those under age 20 years. The sensitivity and specificity of lymph node FNA in the diagnosis of tuberculosis were 79.5% and 100%, respectively. The overall accuracy rate of lymph node aspiration was 89.5%. Our study showed that FNA is a simple, cost-effective procedure which offers a reliable method of diagnosis in distinguishing reactive lymphadenopathy, tuberculosis, and malignant conditions. Diagn. Cytopathol. 1999;21:159-162.     

Fine-needle aspiration of histiocytic necrotizing lymphadenitis (Kikuchi's disease)

Fine-needle aspiration (FNA) of the lymph node was done in five patients with histiocytic necrotizing lymphadenitis (Kikuchi's disease). In four patients, the aspirates were found to have many small and large atypical lymphocytes, some reactive, phagocytic histiocytes, and intense extracellular debris. Neutrophils, plasma cells, or multinucleated giant cells were not seen. These cytologic findings were considered diagnostic for Kikuchi's disease. In one patient, the aspirate did not show significant histiocytosis or tissue necrosis and was considered nondiagnostic. In patients with both typical clinical features and characteristic cytologic findings in the lymph node aspirates, FNA of the lymph node alone will suffice for diagnosis. In those patients with typical clinical features but nondiagnostic findings in the FNA aspirates, the diagnosis of Kikuchi's disease may have to be established either on repeated nodal FNA or on lymph node biopsy.     

Expression of androgen, oestrogen alpha and beta, and progesterone receptors in the canine prostate: differences between normal, inflamed, hyperplastic and neoplastic glands

The aim of this study was to compare immunolabelling of cytological specimens with conventional staining in the detection of metastases in lymph nodes from dogs with carcinoma. Cytological touch imprints of 161 lymph nodes from 72 dogs, as well as 50 fine needle aspirates from 23 dogs, with malignant epithelial tumours were included in the study. Immunolabelling was performed with commercially available human antibodies. Touch imprints of all lymph nodes were labelled with broad spectrum anticytokeratins AE1/AE3 and KL1. In addition, lymph node touch imprints from dogs with primary tumours that reacted positively with the specific anticytokeratins CK7 (n=104) and CK20 (n=20) were also labelled with CK7 and CK20. Fine needle aspirates of 50 lymph nodes were examined by immunolabelling with AE1/AE3. "Reference investigations" with a combination of histological and immunohistochemical methods were performed on all lymph nodes. The immunocytological detection of lymph node metastases with the broad spectrum anti-cytokeratin AE1/AE3 in imprint smears resulted in a significant increase in sensitivity (0.99 vs 0.88 [conventional stain]) and in negative predictive value (0.99 vs 0.85) (P<0.01; t-test). Micrometastases in particular were detected more readily. Specificity (0.93 vs 0.88) and positive predictive value (0.95 vs 0.90) did not differ significantly between the two techniques. Immunolabelling with KL1 was associated with lower sensitivity and negative predictive value, indicating lack of cross-reactivity of this antibody with canine epithelial cells. In fine needle aspirates the detection of lymph node metastases, especially micrometastases, was more efficient by mean of immunolabelling with AE1/AE3 than by conventional staining. The study indicated the value of immunocytological labelling for the detection of metastases in cytological specimens of canine lymph node preparations.     

Rapid method for detecting monoclonality in B cell lymphoma in lymph node aspirates using the polymerase chain reaction.

AIMS: To use the polymerase chain reaction to detect monoclonality at the immunoglobulin heavy chain gene locus in cells derived from lymph node aspirates. METHODS: A nested two-stage polymerase chain reaction (PCR) for the VDJ region of the immunoglobulin heavy chain gene was used to detect monoclonality. The total number of cells available for diagnosis by PCR in lymph node aspirates was between 10(4) and 10(5). RESULTS: A monoclonal band was detected in 21 of 25 malignant B-lymphomas. The other four specimens gave polyclonal bands. Specimens from reactive lymph nodes produced polyclonal bands in 14 cases, no product in two cases, and one specimen gave two monoclonal bands. Polyclonal bands were obtained for three Hodgkin's lymphoma samples and five metastatic carcinomas. Four metastatic carcinoma samples gave no amplification. CONCLUSIONS: Detection of monoclonality in a cell population is strongly suggestive of malignant disease. The simple PCR method presented here should complement conventional cytological and immunological methods for diagnosis of malignancy by lymph node aspirates.     

Evidence of antibody production in the rat cervical lymph nodes after antigen administration into the cerebrospinal fluid

We previously showed histologically that, in the rat, the cerebrospinal fluid drains from the subarachnoid space along the olfactory nerves to the nasal lymphatics and empties into the superficial and deep cervical lymph nodes. The present study was performed to investigate whether these lymph nodes play a role in the immune response of the central nervous system. For this purpose, keyhole limpet hemocyanin conjugated with fluorescein isothiocyanate (KLH-FITC) was administered into the subarachnoid space of the rat brain, and the time-kinetics and location of FITC and anti-FITC antibody forming cells in the cervical lymph nodes were studied histologically and immunohistochemically. FITC fluorescence was detected in superficial and deep cervical lymph nodes as well as the subarachnoid space and the nasal mucosa 2 h after FITC-KLH injection into the subarachnoid space. The specific antibody-forming cells first appeared in both the superficial and deep cervical lymph nodes on the 4th day after antigen administration although the reaction was more intense in the deep than in the superficial cervical lymph nodes. These cells were located in the medullary cords of the cervical lymph nodes. The number of antibody forming cells increased thereafter, reached a peak around the day 6, and then declined on day 10. These findings indicate that antigens introduced in the cerebrospinal fluid are drained into the cervical lymph nodes through the nasal lymphatics and initiate the antigen-specific immune response there. Thus, the cervical lymph nodes probably act as a monitoring site for cerebrospinal fluid and play a major role in the central nervous system immune response.     

Cellular swirls in fine needle aspirates of papillary thyroid carcinoma: a new diagnostic criterion.

No single cytologic feature is specifically diagnostic for papillary thyroid carcinoma. We report herein the presence of swirl-like cellular aggregates in fine needle aspirates of papillary thyroid carcinoma but not in other thyroid entities. Cellular swirls are defined as concentrically organized aggregates of tumor cells in which many of the most peripherally situated cells have ovoid rather than round nuclei that are oriented perpendicular to the radius of the swirl. One hundred Papanicolaou- and/or Diff-Quik-stained FNAs of the thyroid diagnosed as papillary carcinoma, including seven fine needle aspirates of cervical lymph nodes showing metastatic papillary carcinoma, with or without cell blocks, were reviewed for the presence of cellular swirls. An additional 100 thyroid FNAs, similarly stained and prepared, diagnosed as nodular goiter, Hashimoto's thyroiditis and follicular neoplasm were also reviewed for the presence of cellular swirls. Cellular swirls were easily observed at screening magnification and confirmed at high magnification. Seventeen of 100 FNAs (17%) of papillary carcinoma contained cellular swirls. No cases diagnosed as nodular goiter, Hashimoto's thyroiditis or follicular neoplasm contained these structures. Thirteen cases with swirls had histologic follow-up. These comprised seven papillary carcinomas with classical histopathology, two designated 'differentiated papillary carcinoma,' two with follicular variant histopathology; one with a minor component of follicular variant histopathology; one papillary carcinoma metastatic to a cervical lymph node with classic histopathology. Swirls occurred in cases with relatively little pleomorphism, or in well-differentiated regions of papillary carcinoma that also displayed less well-differentiated components. Cellular swirls are a finding that is highly specific to papillary thyroid carcinoma. They are easily seen at screening magnification. Their presence in a FNA specimen may be helpful in cases where classic criteria for papillary thyroid carcinoma are scarce, particularly in well-differentiated papillary thyroid carcinoma. While the size and scope of this study are insufficient to conclude that cellular swirls alone are diagnostic of papillary thyroid carcinoma in the absence of other criteria, we believe these structures should be added to the list of diagnostic criteria.     

Amplification of human papillomavirus type 16 transforming genes from cervical cancer biopsies and lymph nodes of Hungarian patients.

We have used a polymerase chain reaction (PCR) to examine cervical cancer biopsy specimens and pelvic lymph nodes for the presence of human papillomavirus type 16 (HPV 16) DNA. Of the 75 cervical specimens tested, 36 (48%) were positive for HPV 16 in the PCR. A total of 65 pelvic lymph nodes removed during radical surgery on 35 women were also analyzed. Lymph nodes originating from 19 patients whose cervical biopsy specimens were negative for HPV 16 seemed to lack HPV 16 sequences. For 16 women with positive PCR results for cervical biopsy specimens, 9 of 10 lymph node metastases were positive in the PCR, while 11 of their 36 histologically negative lymph nodes were also shown to contain HPV 16 DNA.     

Cystic change in metastatic lymph nodes: a common diagnostic pitfall in fine-needle aspiration cytology

Fine-needle aspiration cytology (FNAC) of cystic metastases is a challenging diagnostic category and has been investigated in a limited number of malignancies and sites. The present study retrospectively reviewed 1,211 FNAC of superficial masses, including lymph nodes (1,102 aspirates), benign cystic lesions (64 aspirates), and lymphocysts (45 aspirates) with the aim of determining the tumors that cause cystic change in metastases. Cytology results from 1,102 lymph node aspirations were suspicious or positive for malignancy in 541 specimens (49.1%), benign in 230 (20.9%), and unsatisfactory in 331 (30%). There were 28 malignant aspirates demonstrating cystic change (5.2%). The tumor type that most frequently caused cystic change was thyroid papillary carcinoma (42.8% of cases), followed by squamous cell carcinoma (primary in the head and neck region 30.8% and in the skin 24%), tumors of unknown origin (6.3%), serous papillary carcinoma of the ovary or endometrium (4.8%), and malignant melanoma (2.1%). Cystic change was observed most commonly in the head and neck region lymph nodes (60%). The most challenging lesions to assess using FNAC were metastatic lymph nodes showing cystic change, accounting for six of the 16 false-negative diagnoses and one false-positive diagnosis. The results of this study suggest that cystic change in metastatic lymph nodes occurs in certain types of tumors and is an important cause of diagnostic error. FNAC should be repeated in case of suspicious hypocellular cystic aspirations, especially in patients with known malignancy.