谢谢 dingwei 老师,学习了.

 也没想到，学习。

 大部分的胞核是椭圆的，没考虑到。学习了。

 This case is a very good educational case. I just showed the pictures to one of my very experienced cytopathologists, his immediate reaction actually was could those cells be "epithelioid histiocytes", no surprise to me, because sarcoidosis is very common in the US, but I guess rare in China. On the other hand, nasopharyngeal carcinoma is very common in China, but not in the US. My general approach to FNA is quite conservative. I usually try to exclude the possibility of benign conditions and especially those can mimic malignancy and then pull the trigger for malignancy. In this case, I would definitely get a cell block and do some immunostains of keratins. I am wondering how you sign the cytology report?

 说实话，俺看那些均匀一致的细胞像类上皮细胞，只是纳闷成分单一了些。但凭这些不敢去想癌或其它恶性肿瘤。

学习了，谢谢！

 学习中

 活检证实：鼻咽癌转移

个人觉得，木块撞击后肿大可能是一种“巧合”，因为局部本身存在病变“易于受伤”。再说，若是外伤所致，似乎应该看到更复杂些的成份以符合其外伤后的多种反应性细胞成份？

 

突发奇想，如果是异位的梭形细胞胸腺瘤或许也可以是这样的穿刺图像？

 

这个部位比较常见的鼻咽癌转移灶的可能性还是要列为常规鉴别的。

 觉得是良性病变-------- Can you be more specific?

 颈部淋巴结肿大二月，自诉：因为木块撞到后，肿大------- Is this history provided by the author helpful?

 觉得是良性病变

图片看着很清晰，诊断思路却很模糊。

看起来已经不是正常淋巴结成份了。

穿刺成份很清爽，病变细胞成片粘附力尚可，无松散迹象，没有坏死，基本没有炎症细胞夹杂。

细胞核看起来大了些，不太规则，有核仁，大小欠一致，但是染色质很柔和、浅淡。核质比中等；粉红的胞质很细腻，让人想起来神经原纤维。没见到分裂像。有些细胞似梭形，也可能是涂片外力的作用。没看到明显的主质、间质之分，有些核似乎能看到核沟。

猜一个：良性或交界性。付节瘤？

 This is a very interesting cases and the differential diagnosis includes both benign and malignant conditions. Please post your discussions.

 梭形及卵圆形细胞，染色质细致，见核沟，首先考虑朗格韩氏细胞瘤，其次考虑转移癌。