Diagnostic Pitfalls and the Critical Role of Excisional Biopsy in Non-Hodgkin’s Lymphoma: A Case Report

Lymphomas often pose significant diagnostic challenges, particularly when they present with atypical clinical features that can mimic other conditions. This complexity can lead to delays in accurate diagnosis and appropriate treatment. A 30-year-old female patient presented with a recurrent swelling in the cervical region. Despite multiple Fine Needle Aspiration Cytologies (FNACs) performed on the swelling, the diagnosis remained unclear and initial results were misleading. These cytological evaluations failed to definitively identify lymphoma, contributing to a delay in establishing the correct diagnosis. The present highlights common diagnostic pitfalls encountered in lymphoma detection, especially when relying solely on minimally invasive procedures like FNAC. While FNAC is a useful initial tool for evaluating lymphadenopathy, it has limitations in distinguishing lymphoma from reactive or other malignant processes due to sampling error and cytological overlap. Consequently, an excisional biopsy, which provides a larger tissue sample for detailed histopathological and immunohistochemical analysis, is essential for accurate diagnosis. This approach allows for a comprehensive examination of tissue and cellular characteristics, which are critical for classifying lymphoma subtypes and guiding treatment decisions. Despite advances in less invasive diagnostic techniques, histopathological examination of excised tissue remains the gold standard for definitive diagnosis in suspected lymphoma cases. Clinicians should maintain a high index of suspicion and proceed to excisional biopsy promptly when lymphoma is suspected but FNAC results are inconclusive, to avoid delays in diagnosis and improve patient outcomes.