<s>[INST] Excision biopsy of cervical lymphadenopathy on the right side in 2004 showed confluent epithelioid granulomas.  Areas of hyalinization and necrosis also seen.  Multinucleite giant cells of Langhans type noted.  Z-N staining did not reveal acid fast bacilli despite intensive search.  No atypical cells observed.  Diagnosis:  Granulomatous lymphadenopathy ?tuberculosis ?? sarcoidosis. Bactec culture showed no growth of Mycobacterium species after 6 weeks of incubation. In Feb 2010 granulomatous lymphadenitis on the left side of the neck with FNAC showing epithelioid cells present as single cells or clusters.  Occasional multinucleated giant cell is seen.  No caseation identified.  What could be the diagnosis for this cervical lymphadenopathy? [/INST] Thanks for your question on Chat Doctor. I can understand your concern. In my opinion, this patient should start anti-tubercular Chat Doctor. Tubercular Lymphadenopathy is much more common than acidosis. Acidosis is more common in mediastinal lymph node. TB is more common in cervical lymph node. So even if culture is negative, absence of cassation necrosis, we should definitely go for anti-tubercular  </s>