Abstract
A 73-year-old woman was found to have a 1.7 cm axillary mass, for which a core needle biopsy was performed. The specimen revealed fragmented squamous epithelium surrounded by lymphoid tissue consistent with a squamous inclusion cyst in a lymph node, but a metastatic squamous cell carcinoma could not be excluded. Within one month, the lesion enlarged to 5 cm and was excised. Touch preparation cytology during intraoperative consultation displayed numerous single and sheets of atypical epithelioid cells with enlarged nuclei and occasional mitoses, suggesting a carcinoma. However, multinucleated giant cells and neutrophils in the background indicated reactive changes. We interpreted the touch preparation as atypical and recommended conservative surgical management. Permanent sections revealed a ruptured squamous inclusion cyst in a lymph node with extensive reactive changes. Retrospectively, the atypical epithelioid cells on touch preparation corresponded to reactive histiocytes. This is the first case report of a rapidly enlarging ruptured squamous inclusion cyst in an axillary lymph node following core needle biopsy. Our case demonstrates the diagnostic challenges related to a ruptured squamous inclusion cyst and serves to inform the readers to consider this lesion in the differential diagnosis for similar situations.
Highlights
Benign epithelial inclusions in lymph nodes refer to nonneoplastic ectopic epithelium in lymph nodes
While most epithelial inclusions in axillary lymph nodes consist of glands alone or associated with cysts lined by apocrine or squamous epithelium [4, 8, 9, 14, 15], five others have been described as cysts lined by apparently pure stratified squamous epithelium with a prominent granular cell layer and hyperkeratosis [5,6,7,8, 10]
We report a rapidly enlarging squamous inclusion cyst of the axillary lymph node following core needle biopsy, mimicking malignancy during pre- and intraoperative workups
Summary
Benign epithelial inclusions in lymph nodes refer to nonneoplastic ectopic epithelium in lymph nodes. Epithelial inclusions in axillary lymph nodes are uncommon tumor-like lesions, with only about 40 cases reported in the literature [4,5,6,7,8,9,10,11,12,13]. We report a rapidly enlarging squamous inclusion cyst of the axillary lymph node following core needle biopsy, mimicking malignancy during pre- and intraoperative workups
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