01/06/2026
š¬ | A Closer Look at Diagnosis in Action
A 25-year-old Asian man presented with several months of nasal congestion that had been treated with over-the-counter remedies like nasal rinses. During an ENT visit, both a neck mass and a nasal mass were identified, prompting further evaluation.
Microscopic review of the lymph node sample revealed atypical dispersed cells with a few small clusters and clear anisonucleosis, meaning variation in nuclear size and shape. At this stage, the pattern raised concern for malignancies that often appear as single cells rather than organized groups, including lymphoma, sarcoma, melanoma, or a very poorly differentiated carcinoma.
Because lymphoma was a consideration, additional material was collected while the patient was still in the office for flow cytometry. When those results came back negative, further testing was performed using immunohistochemistry on the cell block, a concentrated preparation of cells that resembles tissue. The results were positive for carcinoma markers and EBV (EpsteināBarr virus), findings that point toward nasopharyngeal carcinoma, a high-grade cancer of the nose and pharynx.
This case highlights why immediate microscopic evaluation and step-by-step diagnostic testing matter. Each decision under the microscope directly shaped the next step in care and led to a clear diagnosis without delay.
š§ What stood out to you in this case ā the cell pattern, the testing sequence, or the role of EBV?
