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To the Editor,
The cervical lymph nodes (LNs), along with being the primary site of lymphomas, are also the draining sites for malignancies of the gastrointestinal tract, breasts, lungs, etc. Hodgkin's disease also most commonly affects the cervical and axillary LNs. We, in the era of modern techniques for diagnosing malignancies, stress the fact that a diligent histopathological examination of the background lymphoid tissue is important to exclude a coexistent lymphoma, particularly after a metastasis is found.
A 55-year-old hypertensive male presented with significant weight loss and vague epigastric fullness for the past month. On examination, splenomegaly (13.4 cm) and multiple left level IV and V cervical LNs measuring between 1 and 1.5 cm were noted. Investigations revealed anemia (73 g/L) with thrombocytopenia (120x109/L). Peripheral smear showed a leukoerythroblastic blood picture, for which bone marrow (BM) examination was advised. The BM aspirate was hemodiluted; however, a BM biopsy showed diffuse infiltration by acini and cords of signet ring cells with abundant mucinous cytoplasm and eccentric nuclei (Figures 1A and 1B), which were positive for cytokeratin (Figure 1C, 200x) and Alcian blue/periodic acid-Schiff staining (Figure 1D). The surrounding area showed desmoplasia with normal marrow elements. Diagnosis of metastatic adenocarcinoma, possibly primarily from the gastrointestinal tract, was given...