Liguoxia71 and 广秀: You are correct. One of my colleagues showed me this case and spindle cell/pleomorphic lipoma is in our consideration, but given the atypia, we signed the case out as "atypical cells present, recommend surgical excision", the surgical pathology showed spindle cell/pleomorphic lipoma.

 如果是颈后软组织的肿物，那有可能是多形性脂肪瘤。

报：atypical     cells   suspicious for  pleomorphic  lipoma。

 The above discussions are good. I usually simplify the cytology diagnosis into 3 categories: 1) Definitely benign; 2) Definitely malignant; 3) I don't know (which you will usually sign-out as some kind of atypical cells). If you think that all the FNA cytology like this way, FNA cytology is easy. I mentioned once to my cytology fellow and resident that sometimes I don't konw what the diagnosis is, but I can still sign out the report. The difficulties of FNA cytology are that you don't want abuse the atypical category (the more experience you have that less atypical cases you will sign out) and  what brand of "atypical cells" to put on the final report (Atypical suspicious for malignancy or atypical cannot exclude malignnacy or atypical not diagnostic of malignancy). It is the art of cytology to let your clinician to understand your atypical diagnosis and patient will get appropriate diagnosis.

 OK, back to this case, nobody seems to vote for benign, it is either Atypical cells, recommend biopsy, or atypical suspicious for malignancy, or definite malignant. What if I talk to the clinician and he said this is a soft mass in the patient's posterior neck?

有可能啊.

脂肪组织和少量淋巴细胞，夹带少数异型细胞。

 试着解释一下：

pic1：成熟鳞状上皮，无异型，可能是穿刺带入的皮肤组织；

pic2-4：背景为淋巴细胞，散在异型大细胞，有的多边形，胞浆丰富，核异型明显，碳核样，故鳞癌可能。

综合：淋巴结转移性鳞癌。查肺、鼻咽等。