A rare case of squamous inclusion cyst in cervical lymph node

Area of Science:

• Pathology
• Surgical Pathology
• Head and Neck Pathology

Background:

• Cervical lymphadenopathy is common, with tuberculosis and metastatic carcinoma being frequent considerations.
• Squamous inclusion cysts are benign lesions typically found in the skin, rarely presenting as rapidly enlarging lymph node masses.
• Distinguishing benign cysts from malignancy in lymph nodes poses a significant diagnostic challenge.

Observation:

• A 38-year-old man presented with a rapidly enlarging 2 cm jugular lymph node, initially suspected to be lymph node tuberculosis.
• Histopathological examination revealed a cystic structure lined by keratinizing squamous epithelium with a granular cell layer, consistent with a squamous inclusion cyst.
• Metastatic squamous cell carcinoma could not be definitively excluded based on initial findings.

Findings:

• This report details the first case of a rapidly enlarging squamous inclusion cyst within a jugular lymph node.
• The histological features mimicked malignancy, presenting a diagnostic dilemma.
• The lesion was confirmed as a squamous inclusion cyst, despite its unusual presentation and rapid growth.

Implications:

• This case underscores the importance of considering benign squamous inclusion cysts in the differential diagnosis of rapidly enlarging cervical lymphadenopathy.
• Awareness of this rare presentation can prevent misdiagnosis and unnecessary aggressive treatment.
• Further investigation into the pathogenesis of rapidly growing lymph node inclusion cysts may be warranted.