Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 73414

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2011 | Month : October | Volume : 5 | Issue : 5 | Page : 1016 - 1019 Full Version

Cytomorphological study of Lateral Neck Swellings

Published: October 1, 2011 | DOI:
Manjula K., C.S.B.R. Prasad, Gayathri B.N., Harendra Kumar

Department of Pathology, Sri Devaraj Urs medical College, Tamaka, Kolar

Correspondence Address :
Manjula. K
Address- Asst. Profesor. Sri Devaraj Urs Medical College
Tamaka, Kolar, Karnataka-563101
Phone: 8951374212


Background: Swellings in the neck may be due to various causes. These swellings can be divided into midline swellings and lateral neck swellings (LNS). The common swellings are lymph node swellings, salivary gland enlargement, thyroid enlargement and branchial cyst. A neck mass in a 50- year-old smoker is different from neck mass in 15-year-old with respiratory tract infection.

Fine needle aspiration cytology (FNAC) has become an important first line of investigation in palpable masses. It is one of the most useful accurate, sensitive, inexpensive, and rapid investigation available in the assessment of patients with lateral neck swellings.

Aims: To find out the relative frequencies of various pathological conditions presenting as lateral neck swelling with respect to age and sex. And also to evaluate the role of FNAC in their diagnosis.

Methodology: This study was undertaken in the Department of Pathology, Sri Devaraj Urs Medical College, over a period oftwo years from January 2009 to December 2010. FNAC was done on patients who presented with lateral neck swelling. The cytological features were evaluated. The accuracy of FNAC was verified by histopathological examination in 70 cases.

Results: The study included 386 patients, with mean age of 24.5 years and male predominance. FNAC revealed that non neoplastic conditions of the LNS were in 251 (66.05%) cases, malignant neoplasms were in 104 (27.36%) cases and benign neoplasms were in 25(6.57%). Among the malignant neoplasms, metastatic squamous carcinoma was the commonest.

Conclusions: Reactive lymphadenitis is the commonest cause of LNS in children and in adolescence and squamous cell carcinoma is the commonest cause of LNS in patients older than 40 years. FNAC of lateral neck swellings is useful in diagnosis, can differentiate neoplastic and non neoplastic lesions.


Lateral neck swellings, FNAC, lymphadinitis

Swellings in the neck may be due to various causes. These swellings can be divided into midline swellings and lateral neck swellings (LNS). The common swellings are lymph node swellings, salivary gland enlargement, thyroid enlargement and branchial cyst (1). A neck mass in a 50-year- old smoker is different from neck mass in 15-year-old with respiratory tract infection. Lateral neck swelling in an adult is a common presentation for primary and secondary malignant lesions. Paediatric neck swellings differ from those in adults in that malignancy is much less likely (2).

The gold-standard procedure for the diagnosis of a neck swelling is open biopsy of the swelling with histopathological examination of the excised tissue. However, open biopsy of a metastatic cervical swelling prior to definitive treatment of the neck (usually by radical neck dissection) has been reported to lead a higher incidence of wound complications, regional neck recurrence and distant metastasis, than in patients who have no biopsy performed prior to definitive treatment (3),(4),(5).

FNAC has become an important first line of investigation in palpable masses anywhere in the body but especially in the head and neck area, sometimes replacing but complimenting tissue pathology in many clinical situations. It is a form of surgical pathology, practiced on cytologic samples. It is one of the most useful accurate sensitive, inexpensive, and rapid investigation available in the assessment of patients with LNS (6).

Material and Methods

This study was undertaken in the Department of Pathology, Sri Devaraj Urs Medical College, over a period of two years from January 2009 to December 2010. FNAC was done on patients who presented with LNS. Only patients presenting with LNS were included in the study. Swellings in the mid line of the neck and other area were excluded from the study. Prior to FNAC, clinical details regarding food habits, smoking, chewing pan, occupation, age of the patient at the onset of the swelling, its duration, change in size, and associated systemic symptoms were noted.

FNAC was done using a 22-24 gauge needle fitted to a 10 ml disposable syringe. After immobilizing the target swelling multiple passes are given to get sufficient material. Smears were prepared and stained with May- Grunwald Giemsa stain (MGG), haematoxylin and eosin (H &E) and Papanicolaou stain. The Zeihl- Neelsen’s stain for AFB was done in those cases, where the clinical suspicious or diagnosis was tuberculosis and in those cases where purulent or cheesy material was aspirated. A repeat FNAC was done in cases where the yield was inadequate in the first aspiration. The cytological features evaluated included cellularity (scanty, moderate and high), cell arrangement, nuclear and cytoplasmic characteristics, and background elements. Surgically excised specimens were routinely processed and stained with H and E. Histopathological findings were compared with cytological reports and sensitivity, specificity, predictive values and accuracy of FNAC were calculated.


The study included 386 patients with LNS. Six were excluded from the study as the smears were unsatisfactory. There were 225 (59.21%) male patients and 161 (42.36%) female patients with male to female ratio of 1.39:1. Age range varied from 4 months to 84 years with the mean age of 24.5 years. FNAC revealed that malignant neoplasm of the LNS were in 104 (27.36%) cases, benign neoplasms were in 25 (6.57%) cases and non neoplastic conditions of LNS were in 251 (66.05%) cases. The distribution of the 380 cases is given in (Table/Fig 1). The most common LNS seen were an enlarged lymph node due to inflammation (49.2%). Other were, malignant neoplasms (27.36%), benign neoplasms (6.57 %), non neoplastic thyroid lesions (6.05%), sialadinitis (3.42%) and others (2.89%) where FNAC was inconclusive. Reactive lymghadinitis is the commonest condition presenting as LNS in children aged less than 10 years, malignant neoplasms were the common condition presenting as LNS in patients aged more than 40 yrs (Table/Fig 2). Among the malignant neoplasms, metastatic squamous cell carcinoma was the commonest, followed by other malignancies shown in (Table/Fig 3). The accuracy of FNAC was verified by histopathological examination in 70 cases. The sensitivity of FNAC in this study was 89.5%, specificity was 100%, the positive predictive value was 100%, and the negative predictive value was 12.5%.


All the 380 cases of LNS were analyzed with their history, clinical presentation, FNAC and available histopathology. Six cases (1.55%) were excluded, as they were inadequate. The incidence of inadequate or unsatisfactory samples in various studies ranged 0 to 25 (7). Unsatisfactory aspirates in the previous studies were the result of poor handling of the aspirated material and lack of trained cytopathologists (8) whereas inadequacy in the present study was attributed to firm small swellings and uncooperative patients.

Reactive lymphadenitis was the commonest condition in our study which correlates with other studies shown in (Table/Fig 4) (9), (10),(11). The most common lateral neck swelling seen in children and adolescences were enlarged lymph nodes. Reactive lymphadenitis may occur as a part of specific disease or purely as a non- specific response (12). It is important to note the location of the lymphadenopathy, size of the lymph nodes, mobility, and consistency. After appropriate treatment, however, if the lymphadenopathy persists or continues to enlarge, FNAC is appropriate (13).

Tuberculous lymphadenitis was the second common inflammatory condition in our study, accounting to 16.84%. Frequency of incidence varies from 13% to 52% in different studies. Advanced tests, such as Enzyme Linked Immunosorbent Assay (ELISA) for serum Ig M and Polymerase Chain Reaction (PCR), are very costly and are unavailable at all centers in developing countries. The patients are treated with unnecessary antibiotics or undergo incisionand drainage (I&D). Morbidity increases due to complications. All these favour an early diagnosis by FNAC (14).

Malignant neoplasms were the commonest cause of LNS in patients older than 40 years. Frequency of incidence in the present study is comparable to Alseman (3), whereas in other studies it varies from 7.5% to 38.6% (5),(10),(11). More than 75% of lateral neck swellings in patients older than 40 years are caused by malignant neoplasm, and the incidence of neoplastic cervical adenopathy continues to increase with age, particularly those with alcohol abuse and heavy smoking (15). Neck metastases present mostly as firm, solid masses, but a distinct subset of metastatic nodes present as cystic masses frequently related to thyroid carcinoma followed by squamous cell carcinoma and malignant melanoma (16).

Non-neoplastic thyroid lesions accounted for 6% of lateral neck swellings. Most common lesion was colloid goiter with cystic change. One must be careful in committing a false negative diagnostic error in the cystic lesions that contain macrophages and scanty material, since these features do not exclude malignancy. Repeat FNAC or thyriodectomy is advised for persistent nodules (7).

Benign neoplasms of the lateral neck swellings accounted for 6.57% which is comparatively less than the study done by Sheahan P et al (5). The commonest benign lesion was pleomorphic adenoma of salivary gland, which showed various combination of three elements: ductal cells, chondromyxiod matrix and myoepithelial cells. We reported a case of paraganglioma in 50 year old male patient presenting as LNS (Table/Fig 5).

Benign cystic lesions were found in 4.47% of cases, comparatively less than other similar studies (5),(10),(11). The common cyst was epidermal cyst, others were branchial cleft cysts, thyroglosal duct cysts and we reported one case of cystocercosis presenting as cystic LNS (Table/Fig 6). The most cystic lesions in the lateral neck are benign entities. Necrosis and nuclear grade are very useful indices to differentiate benign from malignant lesions.

Cervical lymph node metastasis presenting as lateral neck swellings can be found in every neck level. In general, nodes in level 1 to 3 are attributed to a presumable primary SCC located in the mucosa of the upper aerodigestive tract, whereas nodes in level 4 and 5b more often arise from proximal oesophageal and thyroid carcinoma, but can also originate from distant organs in the body, often containing adenocarcinoma or large cell undifferentiated carcinoma. Lymph nodes in level 2b and 5a are more typical of nasopharyngeal cancer. (16)

In our study, The most common tumour metastatizing to the neck nodes was the squamous cell carcinoma (16.84%) shown in (Table/Fig 7). Smears composed of cells arranged in tight clusters, loosely scattered cells showing various degrees of keratinization seen. It has been observed that certain squamous cell carcinoma more likely to produce metastases that are cystic. These sites predominately include primary tumours of the tonsil tissue from Waldayer’s ring (18), we had four cases of cystic squamous cell carcinoma. However, when squamous-lined cysts of the lateral neck are considered, the distinction between a congenital cyst and a metastatic squamous cell carcinoma with cystic change can be difficult or impossible to make with confidence (19). All patients over 40 years old who present with a lateral cystic neck mass must be presumed to have a cancer until proven otherwise, should be excised, as it is impossible to pre-operatively establish if it is benign or malignant (20).

Papillary carcinoma of thyroid was reported in 13 cases. Aspirates showed papillary branching, three-dimensional groups of cells with ground glass nuclei, nuclear grooves (Table/Fig 8). Metastases in levels 3, 4, 6 should raise suspicion of a primary thyroid malignancy (17). Metastatic adenocarcinoma can originate from either salivary gland or other primary sites including breast, lung, kidney, prostate and gonads. Smears composed of round to columnar cells with abundant cytoplasm, hyperchromatic nuclei, and prominent nucleoli often with mucinous background seen. Cells with vacuolated cytoplasm, signet ring cells were also seen. Metastatic small cell carcinoma was reported in 3 cases. Cells were small with indistinct cytoplasm, chromatin was salt and pepper type (Table/Fig 9). Nuclear dust, individual cell death and nuclear molding were also seen.


It is concluded from the present study that, reactive lymphadenitis is the commonest cause of LNS in children and in adolescence and squamous cell carcinoma is the commonest cause of LNS in patients older than 40 years. FNAC of lateral neck swellings is useful in diagnosis, can differentiate neoplastic and non-neoplastic lesions. When neoplastic, the diagnosis of benign or malignant tumour allows the surgeon to plan the operative approach. If found to be inflammatory or reactive lesion, surgery can be avoided.


The neck. In, Das S( ed). A concise textbook of surgery, 3rd edition. Calcutta 2001; 617-41.
Ryan J, Mahadevan M. Neck swellings in children. Current therapeutics 2001 June; 49-53.
Alsamen AA, BasheerA, Rish KAA, Ebous AA, Abdallat M. JRMS 2010 ; 17: 33-7.
Patt BS, F, Shaefer SD, Vuitch F. Role of fine needle aspiration in the evaluation of neck masses. Med Clin N Am 1993; 77:611-23.
Sheahan P, Fitzgibbon JG, Leary OG, Lee G. Efficacy and pitfalls of fine needle aspiration in the diagnosis of neck masses. Surg J R Coll Surg Edinb Irel 2004; 152-7.
Diagnostic cytology: its origins and principles. In, koss LG, Melamed MR, (ed). Koss’s diagnostic cytology and its histopathologic bases, 5th ed. Philadelphia, Lippincott Williams and wilkins, 2006; 3-20.
Fernandesh H, D,’souz RS, Thejaswini BN. Role of fine needle aspiration cytology in palpable head and neck masses. Journal of clinical and diagnostic research 2009 Oct; 3: 1719-25.
Jain M, Majumdar DD, Bais AAS, Choudhury M. FNAC as a diagnostic tool in pediatric head and neck lesions. Indian pediatrics 1999;36 :921-3.
Ahmad T, Naeem M,Ahmad S, Samad A, Nasir A. fine needle aspiration cytology and neck swellings in the surgical outpatient. J Ayub Coll Abbottabad 2008; 20: 30-2.
Hag IA, Chiedozi LC, Reyees AFA, Kollur SM. Fine needle aspiration cytology of head and neck masses. Seven year’s experience in a secondary care hospital. Acta Cytol 2003; 47:387-92.
Kamal F, Niazl S, Nagi AH, Jaradi MA, Naveed IA. Fine needle aspiration cytology (FNAC) :an experience at king Edward medical college, Lahore. Pak J Pathol 1996; 7: 33-6.
Raghuveer CV, Chethan M, Pai MR. Role of fine needle aspiration cytology in disorders of lymph nodes. J Cytol 1996: 13: 45-9.
Rosenberg TL, Jimmy J, Brown, Jefferson GD. Evaluating the adult patient with a neck mass. Med Clin N Am 2010; 94: 1017-29.
Kumar N, Jain S, Murthy NS. Utility of repeat fine needle aspiration in acute suppurative lesions: follow up of 263 cases. Acta Cytol 2004 may-june; 48: 337-40.
Gleeson M, Herbert A, Richards A. Management of lateral neck masses in adults. BMJ 2000; 320:1521-4.
Balm AJM, Vev velthuysen MLF, Hoebers JP, Vogal WV, Venden brekel MWM. Diagnosis and treatment of a neck node swelling suspicious for a malignancy: An algorithmic approach. International journal of surgical oncology 2010: 1-8.
Retrospective study of 71 cases of fine needle aspiration biopsies of cystic lesions of the head and neck. Cancer cytopathology 2010 : 350.
Bagwan IN, Kane SV, Chinoy RF. Cytologic evaluation of the enlarged neck node: FNAC utility in metastatic neck diseases. The internet journal of pathology 2007; volume 6 number 2.
Soh LBK. Branchiogenic carcinoma: do they exist. J.R.Coll. Surg Edinb, 1998 ; 43: 1-5.
Stanley MW. Selected problems in fine needle aspiration of head and neck masses. Mod Pathol 2002; 15(3): 342-50.

DOI and Others


JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)