Tyagi Ruchita, Munjal Manish, Kaur Pavneet, Kaur Harpreet, Sood Neena
Department of Pathology, Dayanand Medical College AND Hospital, Ludhiana, Punjab, India.
Department of ENT, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.
Diagn Cytopathol. 2017 Jun;45(6):569-573. doi: 10.1002/dc.23698. Epub 2017 Mar 6.
We present an interesting scenario where a 64 years old male presented with a long standing painless, infra-auricular swelling, which had progressively increased in size. Based on the site, the clinical impression was of a salivary gland lesion and FNAC was performed. The smears were unusually cellular and had necrotic background. The cytological diagnosis was a cystic neoplasm of salivary gland, possibly mucoepidermoid carcinoma. Warthin's tumor was also kept in differential. However, the radiological investigations, which were made available after the FNAC report were conflicting with cytological diagnosis of a malignancy and were characteristic of a carotid body tumor, generally a benign neoplasm. Surgical excision of the tumor with regional lymph node sampling was done and histopathological examination solved the puzzle by revealing metastasis of paraganglioma to right posterior triangle lymph nodes. This case is unique because of the unusual presentation of a malignant paraganglioma as an infra-auricular swelling, which was clinically considered as a parotid tumor. The clinician as well as the pathologist need to be aware of such diagnostic pitfall. Diagn. Cytopathol. 2017;45:569-573. © 2017 Wiley Periodicals, Inc.
我们呈现了一个有趣的病例，一名64岁男性出现耳下长期无痛性肿胀，且肿胀大小逐渐增大。根据病变部位，临床考虑为涎腺病变并进行了细针穿刺抽吸活检（FNAC）。涂片细胞异常丰富且有坏死背景。细胞学诊断为涎腺囊性肿瘤，可能为黏液表皮样癌。沃辛瘤也在鉴别诊断范围内。然而，在FNAC报告之后进行的放射学检查结果与恶性肿瘤的细胞学诊断相矛盾，其表现为颈动脉体瘤的特征，颈动脉体瘤通常是良性肿瘤。遂对肿瘤进行手术切除并取区域淋巴结进行活检，组织病理学检查发现副神经节瘤转移至右后三角区淋巴结，从而解开了谜团。该病例独特之处在于，恶性副神经节瘤表现为耳下肿胀，临床上曾被认为是腮腺肿瘤。临床医生和病理医生都需要警惕此类诊断陷阱。《诊断细胞病理学》2017年；45:569 - 573。© 2017威利期刊公司
