**6. Diagnostic dilemmas**

Radiologically, a SL reaction can mimic tumor recurrence/deposits in the draining lymph nodes. Hence, differentiating lymphadenopathy caused by a SL reaction and metastatic disease is very important clinically. Definitive diagnosis can be made only by histopathological examination of the lymph nodes.

Granulomas in the draining lymph nodes of malignancy can be both infectious as well as SL reaction. The center of these granulomas may sometimes have nests or isolated tumor cells. Hence, a close scrutiny of such granulomas should be performed to avoid missing metastatic disease. Immunostaining with cytokeratin may be required for recognizing these in difficult cases [38].

Knowledge of the usual tumor behavior along with correlating radiologic and histologic findings is important to avoid misdiagnosis.
