Lumps and Bumps in the Neck
It may not seem this way to you, but the neck is a very big place. It joins the head with the body, and many anatomic structures run through it, like the spine and spinal cord, muscles and blood vessels. The digestive system passes through the neck, starting at the mouth on it’s way to the stomach. The respiratory system travels through it as well in the form of the larynx and trachea. Lymph nodes, salivary glands, nerves and thyroid gland all reside in the neck. The neck is also easily accessible for fine needle aspirations, and therefore many of the FNA biopsies we perform are from structures in the neck.
We often perform FNAs of lymph nodes in the neck. Of the many diagnoses we can make from these aspirates, some include lymphoma, metastatic carcinoma and infections.
Recently we had a number of patients who had aspiration biopsies for lymph nodes that were suspicious for metastatic malignancies. We were able to perform the aspiration biopsy under ultrasound guidance and provide the referring physician and patient with an immediate result.
Malignant neoplasm, suggestive of metastatic melanoma
Fig 1. Ultrasound
Fig 2. Malignant cells
Malignant neoplasm, consistent with metastatic squamous cell carcinoma.
Fig 3. Ultrasound
Fig 4. Malignant cells
In this case we were able to confirm the diagnosis by performing immunohistochemical stains on the cell block sections. Cell blocks are created from FNA specimens when we have enough sample to run it through the tissue processor. The microscopic appearance is more like histology (tissue) than cytology (cells).
Fig 5. Cell block section
Fig 6. Special stains confirming the diagnosis of metastatic squamous cell carcinoma.