FNA intracystic hemorrhage

[DrFNA]

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How likely is an intracyst hemorrhage from a FNA?

The patient is SCCHN (p16+) with a resolved primary (left vallecula) and shrinking nodes elsewhere in the neck, but the node that was originally used to diagnose the SCC was via FNA 6 months ago. There were 5 pokes during that FNA. The first 3 couldn't get enough fluid and the next 2 were tried by another, successfully.

Since then FNA the node has continued to grow ever larger (from 2.2cm to 7+cm). Most recent PET/CT (and PET/MR) shows only mild avidity on the periphery, but there is an internal fluid level consistent
with intracyst hemorrhage. It's not clear if this growth is due to continued infection in the neck or the hemorrhage or a combination of the two.

 

[octopusprime]

Likely necrotic tumor or abscess material; just FNA again to see.
Would have to be a fairly traumatic FNA for that much hemorrhage; trial of abx may help with abscess, too...i assume s/p rads tx.

 

[DrFNA]

Likely necrotic tumor or abscess material; just FNA again to see.
Would have to be a fairly traumatic FNA for that much hemorrhage; trial of abx may help with abscess, too...i assume s/p rads tx.

Thanks for the reply. No rads. Only treatment so far was surgery mid-Sept. The suspected left palatine tonsil was removed and a section of the left vallecula. Only microscopic disease was found in the crypts of the vallecula and no clear margins, but it resolved on its own by the Nov 2 scan. Patient attributes this to alternative immune boosting therapies (herbs, supplements, LDN, mistletoe).

The one remaining (and growing) node is the only concern. Patient isn't interested in rads or chemo and doesn't want to go overboard with a neck dissection if this one node can be isolated and removed. What diagnostics are best here? We could repeat the FNA.

 

[octopusprime]

would try to convince to do radiation--true p16+ H&N scc's have allegedly better outcomes due to increased radiosensitivity.

 

[DrFNA]

would try to convince to do radiation--true p16+ H&N scc's have allegedly better outcomes due to increased radiosensitivity.

p16+ is certainly less stable than p16-. That said, I'm going under the assumption that the patient won't want radiotherapy and I want to provide the best diagnostics on that node.