Synchronous ipsilateral sebaceous lymphadenoma and acinic cell adenocarcinoma of the parotid gland

Cytopathology of benign sebaceous salivary gland neoplasia: Comparison of two analogous yet dissimilar entities

INTRODUCTION

Benign sebaceous salivary gland (SG) neoplasms represent approximately 0.2% of all salivary gland neoplasms. Not only are fine needle aspiration (FNA) biopsy findings of sebaceous adenoma (SA) and sebaceous lymphadenoma (SLA) limited, but their findings are also rarely compared with one another.

MATERIALS AND METHODS

Our cytopathology files were searched for examples of benign sebaceous SG neoplasms with concomitant histopathological verification. FNA biopsy and cell collection were performed using standard technique.

RESULTS

One case each of parotid SA and parotid SLA showed markedly dissimilar cytomorphology. The SA case was composed of a repetitive population of profusely multivacuolated polygonal cells with single and multiple nuclei, and was specifically recognised cytologically as a sebaceous neoplasm due to its characteristic cytoplasmic vacuolisation. The SLA case, however, was characterised by smears filled primarily with lymphocytes and only scant widely scattered basaloid cell clusters. A non-specific diagnosis of basaloid neoplasm was rendered. In retrospect, recognition of sebaceous differentiation was limited to rare cell groups.

CONCLUSION

Though nominally, epidemiologically, and to a degree histopathologically analogous, the cytopathology of SA and SLA are markedly dissimilar, reflecting the dominant cell component in each. With FNA biopsy, a specific interpretation is more likely for SA than SLA due to the overwhelming obscuring lymphoid population in the latter.

An invasive presentation of parotid lymphadenoma: A first reported case

Lymphadenoma, a rare benign tumor recognized in the WHO salivary gland tumor classification of 2005, poses diagnostic and treatment challenges due to its rarity and distinct histopathological characteristics. We report a unique case of lymphadenoma in a 45-year-old male patient who presented with a hard, painless tumor in the right parotid gland that had been present since he was 15 years old. Distinctively, MRI and CT imaging revealed signs of infiltration into the surrounding muscle tissues, challenging the traditional notion of lymphadenomas as tumors with clear boundaries. The histopathological examination identified the characteristic epithelial and lymphoid cell proliferation, suggestive of a lymphadenoma. However, the possibility of sebaceous differentiation due to faintly pale cells within the epithelial component was inconclusive. The tumor's invasive nature and the high risk of facial nerve paralysis associated with surgical resection led to the patient's decision against treatment. Findings from this case underline the need for caution in diagnosing lymphadenoma, given its potential to show invasive images and the risks associated with a malignant diagnosis based solely on these images. Furthermore, the observations from this case present new insights into the FDG-PET findings of lymphadenoma, contributing to the overall understanding of this rare tumor's clinical implications. Future studies are warranted to provide more clarity on this condition.

Sebaceous Lymphadenoma: Radiology-Pathology Correlation

Sebaceous lymphadenoma is a rare salivary gland neoplasm most commonly occurring in the sixth to eighth decades of life. Cross sectional imaging typically demonstrates a multicystic expansile mass, most commonly occurring in the parotid gland, where the radiographic differential diagnosis would include Warthin tumor in this location and age group. Ultimately, the diagnosis is confirmed with the histopathologic findings of tubuloglandular epithelial profiles with sebaceous differentiation and cystic change set within a dense, benign lymphocytic infiltrate. These features are exemplified in this sine qua non radiology-pathology correlation article.

Cytomorphology and diagnostic pitfalls of sebaceous and nonsebaceous salivary gland lymphadenoma: A multi-institutional study

BACKGROUND

Salivary gland lymphadenoma (LAD) is a rare benign neoplasm comprising sebaceous (SLAD) and nonsebaceous (NSLAD) types. Despite established histologic criteria, limited data on cytomorphology, tumor heterogeneity, and overlap with other entities make the diagnosis of LAD by fine needle aspiration (FNA) challenging. We describe a multi-institutional cohort of 14 LADs with cytology, clinical, radiologic, and histopathologic data.

METHODS

Our cohort included nine SLAD and five NSLAD with corresponding histopathology. Mean patient age and M:F ratio were 60.4 years (range 45-86 years) and 1:2 for SLADs and 57.4 years (range 42-80 years) and 1:1.5 for NSLADs, respectively. One NSLAD patient had a germline predisposition for Cowden syndrome. Glass slides and whole slide images of air-dried Diff-Quik (DQ), alcohol-stained Papanicolaou smears (Pap) and cellblocks were reviewed for key cytomorphologic findings.

RESULTS

FNAs from SLAD and NSLADs demonstrated vacuolated and basaloid epithelial clusters within a lymphoid background. Vacuolated cells from SLAD showed sebaceous cells with microvesicular cytoplasm indenting a central nucleus. Vacuolated cells from NSLAD were columnar with eccentric nuclei, corresponding to abluminal glandular cells. SLADs were classified using the Milan System for Reporting Salivary Gland Cytopathology as nondiagnostic (11.1%), nonneoplastic (44.4%), atypia of uncertain significance (AUS) (22.2%), and salivary gland neoplasm of uncertain malignant potential (SUMP) (22.2%). NSLADs were classified as AUS (40%), SUMP (40%) and Benign Neoplasm (20%).

CONCLUSION

Although rare, knowing the cytologic features of salivary LAD is important to avoid diagnostic pitfalls. Vacuolated cells can be prominent in both SLAD and NSLAD aspirates. Diagnostic issues arise from insufficient sampling of all tumor components leading to marked variation in diagnostic classification of LAD.

Sebaceous lymphadenoma of parotid gland: A case report of a unique presentation in an immunocompromised patient

Sebaceous lymphadenoma is a rare, benign tumor of the parotid gland accounting for only 0.196% of all adenomas of the parotid gland. Our aim is to present a case of sebaceous lymphadenoma, which has been rapidly enlarging over a period of few months in an immunocompromised patient. This presentation is unusual for a benign salivary gland neoplasm. A 55-year-old female who is a known case of systemic lupus erythromatous, antiphospholipid syndrome, and lupus nephritis, which have been treated by cyclophosphamide, presented with a 2-year complaint of fluctuating painless right parotid swelling, over the last 3 months the swelling started to progressively increasing in size. Physical examination showed a 4 × 3 cm firm, nontender mass in the right parotid gland. The facial nerve was intact and no cervical lymphadenopathy. Fine-needle aspiration cytology (FNAC) revealed marked chronic inflammation and was not helpful for diagnosis. Right superficial parotidectomy was performed without complications and there was no recurrence after 24 months of careful follow-up. In patients presenting with a rapidly enlarging parotid mass associated with an intact facial nerve, the possibility of sebaceous lymphadenoma should be considered as an important differential diagnosis in addition to other benign tumors of the parotid gland. The role of FNAC in this neoplasm is controversial.

Malignant Transformation of Parotid Gland Non-sebaceous Lymphadenoma: Case Report and Review of Literature

Non-sebaceous lymphadenoma is a sporadic benign tumor of salivary glands. Histopathologic and immunohistochemical properties, diagnostic criteria, and theories for the histologic origin of the disease have been defined and well-discussed in the literature. However, none of the cases showed malignant transformation to date. We reported a case of 54 years old female patient with a right preauricular mass. Magnetic resonance imaging demonstrated a 2 cm, well-defined contrast-enhanced mass in the right parotid gland. Fine needle aspiration cytology was undiagnostic but suspicious for malignancy. Total parotidectomy with facial nerve preservation was done. In the histopathological examination, non-sebaceous lymphadenoma regions and malignant cells with abundant cytoplasm, large vesicular nuclei, and prominent nucleoli, which occupied approximately 70% of the mass, were seen. The diagnosis was undifferentiated carcinoma arisen from non-sebaceous lymphadenoma. Adjuvant radiotherapy was given. No recurrence was detected during ten months of follow-up. This case is the first case of a malignancy developed from non-sebaceous lymphadenoma.

Cytologic features of sebaceous, lymphadenoma, and sebaceous lymphadenocarcinoma: Differential diagnostic considerations

BACKGROUND

Sebaceous lymphadenomas and sebaceous lymphadenocarcinomas are uncommon neoplasms occurring predominately within the parotid gland. Cytomorphology of these neoplasms is rarely reported. Occasional reports have discussed the cytomorphological features of these neoplasms but criteria distinguishing sebaceous lymphadenomas from lymphadenocarcinomas have not been described.

METHODS

The senior authors' consultation files and records of the University of Missouri were searched for all cases with a diagnosis of sebaceous adenoma, lymphadenoma, lymphadenocarcinoma, and adenocarcinoma. Slides from these cases were reviewed by the authors for cytologic features characteristic of these neoplasms. These features were compared with other salivary gland lesions in the differential diagnosis and for utility in separating benign from malignant sebaceous neoplasms.

RESULTS

Three sebaceous lymphadenomas and one sebaceous lymphadenocarcinoma were found. Smears contained large numbers of mature lymphocytes dispersed in a watery or bloody background. Scattered among the lymphoid cells were small nests of epithelial cells characterized by a finely to coarsely vacuolated cytoplasm. The majority of cells contained bland nuclei with finely granular chromatin and conspicuous nucleoli. A second population of small basaloid cells was present. The single sebaceous lymphadenocarcinoma had a similar cytomorphology.

CONCLUSIONS

Sebaceous lymphadenomas can be distinguished from other neoplasms within the differential diagnosis due to their prominent lymphoid background and population of epithelial cells with a finely to coarsely vacuolated cytoplasm. The nuclei are bland but have conspicuous nucleoli. Based on our small series, cytomorphologic features are inadequate to definitively separate sebaceous lymphadenomas from lymphadenocarcinomas.

Diagnosis of sebaceous lymphadenoma by fine needle aspiration in a patient with Cowden syndrome: Case report and review of the literature

Sebaceous lymphadenoma (SLA) is a rare benign tumor of the salivary gland that commonly arises in the parotid gland in adults. It is rarely diagnosed correctly preoperatively. In addition, to the best of our knowledge, SLA has not been described yet in the literature in association with Cowden's syndrome (CS). We present an extremely rare case of parotid SLA that was diagnosed preoperatively by fine needle aspiration in a patient with CS.

Synchronous ipsilateral sebaceous lymphadenoma and membranous basal cell adenoma of the parotid

A 46-year-old man presented with persistent right otalgia and hearing loss. Exam was significant for a mildly tender retromandibular mass with intact nonerythematous overlying skin. Computerized tomography with intravenous contrast of the neck revealed 2 relatively well circumscribed masses in the right parotid gland. Although 1 lesion was suspected to be a necrotic lymph node, histologic analysis after superficial parotidectomy demonstrated 2 unique salivary gland tumors. Diagnoses of both sebaceous lymphadenoma and membranous basal cell adenoma were rendered. The occurrence of unique, synchronous, ipsilateral salivary gland tumors is distinctly unusual and this combination of parotid gland neoplasms has not previously been documented. In this report, we present the case with its management, followed by a discussion of the histopathologic nature of each tumor including the possible overlap between these two entities.

Lymphadenoma of the salivary gland: clinicopathological and immunohistochemical analysis of 33 tumors

Lymphadenomas (LADs) are rare salivary gland tumors. Their clinicopathologic characteristics and etiopathogenesis are poorly understood. We examined 33 LADs in 31 patients (17 women and 14 men) aged 11-79 years (median 65 years). There were 22 sebaceous LADs in 21 patients (9 women and 12 men) and 11 non-sebaceous LADs in 10 patients (8 women and 2 men). Two patients had synchronous double tumors. Twenty-six tumors (79%) arose in parotid, three in the neck, and two each in submandibular gland and oral cavity. Extraparotid tumors were seen in 2 of 21 (10%) patients with sebaceous and 4 of 10 (40%) patients with non-sebaceous LADs. Seven of twenty-three (30%) patients had immunosuppressive therapy for unrelated diseases. The tumors were well circumscribed, encapsulated (n=28, 84%) painless masses, varying in size from 0.6 to 6 cm (median 2.2). The cut surfaces were gray-tan to yellow, homogeneous and multicystic (n=24, 72%). The epithelial cells were basaloid, squamous and glandular, forming solid nests, cords, tubules, and cysts. Sebaceous differentiation was restricted to sebaceous lymphadenoma. The epithelial cells expressed basal cell markers (p63, 34BE12, and/or CK5/6, 18/18, 100%) and the luminal glandular cells expressed CK7 (12/12, 100%). Myoepithelial cells were absent (n=10/16, 63%) or focal. The lymphoid stroma was reactive, with germinal centers in 28 (84%). There was no evidence of HPV (0/11), EBV (0/7), and HHV-8 (0/8). Malignant transformation to sebaceous and basal cell adenocarcinoma was seen in one patient each. None of the 11 patients with follow-up (1-8 years) recurred. In summary, sebaceous and non-sebaceous LADs are benign, encapsulated, solid and cystic tumors affecting older adults. Non-sebaceous LADs affect women and extraparotid sites more frequently than sebaceous LADs. Altered immune status may have a role in their etiopathogenesis. Multiple synchronous tumors, origin in buccal mucosa, and malignant transformation may rarely occur.

Synchronous ipsilateral Warthin tumor encased by a separate mucoepidermoid carcinoma of the parotid gland: a case report and review of the literature

Fine-needle aspiration (FNA) is a cost effective and low morbidity procedure in the initial assessment of salivary gland tumors. However, cytological assessment of ipsilateral synchronous tumors (which make up less than 0.3% of all salivary gland neoplasms) may pose diagnostic challenges. Therefore, a wholesome approach, including FNA with clinical and radiological correlation, is of utmost importance. Here, we report a unique case of Warthin tumor encased by a separate high-grade mucoepidermoid carcinoma that was first diagnosed on FNA. Another striking feature seen was the presence of chronic sialadenitis in the surrounding nonneoplastic salivary gland. The presence of two different neoplasms in the background of chronic sialadenitis raises the question of a possible causal relationship. Traditionally, there has been diagnostic difficulty when dealing with synchronous tumors of the salivary gland and the background of chronic sialadenitis may further complicate the diagnosis. FNA is very helpful and can give important cues to the diagnosis.

Sebaceous lymphadenoma of the parotid gland

Sebaceous differentiation in salivary gland tissue is common. However, sebaceous neoplasms within the salivary glands are rare. We present the case of a sebaceous lymphadenoma with unusual features, arising in the parotid gland of a 60-year-old male. To the best of our knowledge, this is the first report of the ultrasound and MRI characteristics of this rare tumour. The difficulties encountered in reaching a definitive diagnosis both radiologically and histologically are described.

[Lymphadenoma of the parotid gland without sebaceous differentiation. Immunohistochemical investigations]

An encapsulated tumor measuring 8 cm was removed from the parotid gland in a 42-year-old man. The tumor had grown for about 5 years. The histopathological and immunohistochemical evaluation revealed a lymphadenoma without sebaceous differentiation of the epithelial component. The tumor consisted of exclusively solid epithelial islands and a lymphoid stroma with rare lymph follicles and abundant predominantly IgG plasma cells. The histogenesis of lymphadenomas is discussed in consideration of the differential diagnosis from Warthin's tumor and the data in the literature.

Synchronous sebaceous lymphadenoma with squamous cell carcinoma - case report

BACKGROUND: Sebaceous lymphadenoma is a rare benign salivary gland tumour of uncertain histogenesis. So is synchronous occurrence of two benign or malignant neoplasms. CASE-REPORT: 68-year-old female presented with right side parotid swelling associated with pain and gradual increase is size. Fine needle aspiration cytology of parotid swelling was suggestive of pleomorphic adenoma. Total conservative parotidectomy was performed and histopathology of the specimen revealed sebaceous lymphadenoma with squamous cell carcinoma. CONCLUSIONS: Sebaceous lymphadenoma and squamous cell carcinoma are two rare benign and malignant neoplasms arising in parotid gland. Synchronous occurrence of these two entities has not been reported.

Synchronous benign and malignant salivary gland tumors in ipsilateral glands: a report of two cases and a review of literature

BACKGROUND

Ipsilateral salivary gland tumors of different histologic types are rare and make up less than 0.3% of all salivary gland neoplasms. Only nine cases of synchronous benign and malignant ipsilateral parotid gland tumors have been described in the literature.

METHODS

Two additional cases of synchronous benign and malignant neoplasms in the parotid gland are reported and discussed with a review of literature.

RESULTS

Our first case describes a pleomorphic adenoma and a salivary duct carcinoma, an entity not previously reported in the literature. The second case documents the most common benign and malignant ipsilateral parotid gland neoplasm reported in this case series, a Warthin's tumor and a mucoepidermoid carcinoma.

CONCLUSIONS

Synchronous salivary gland tumors exhibiting both benign and malignant components are uncommonly observed, with only nine cases published to date. We describe two additional cases of a synchronous benign and malignant ipsilateral parotid gland tumor.