Fine-needle aspiration cytology of monomorphic adenomas

Diagnostic Challenges in the Fine Needle Aspiration Biopsy of Chronic Sclerosing Sialadenitis (Küttner's Tumor) in the Context of Head and Neck Malignancy: A Series of 4 Cases

Chronic sclerosing sialadenitis (CSS) is a benign chronic inflammatory condition of the salivary gland. Clinically, CSS patients may present with a neck mass, often suggesting a neoplastic process. Fine-needle aspiration (FNA) is frequently used to evaluate these lesions. We present a series of 4 patients with CSS, in whom all but one had history of squamous cell carcinoma. The previous diagnosis of malignancy appeared to influence the interpretation of the cytologic preparations. Four patients who had undergone resection of a neck nodule that eventually was diagnosed as CSS were identified. FNA was performed in all 4 cases, and the final cytologic diagnosis in these cases included squamous cell carcinoma, basaloid neoplasm, and salivary gland neoplasm. During intraoperative consultation, the lesions were identified as benign, atrophic salivary gland with chronic inflammation, or sialadenitis with atypical glands. All resected specimens were submitted for histopathological examination and were considered diagnostic for CSS. CSS is a potential pitfall in the FNA interpretation of salivary gland lesions, especially if there is a previous history of head and neck malignancy. Awareness of this entity, adherence to strict cytologic criteria, and careful clinicopathologic correlation are helpful in preventing misinterpretation and unnecessary surgical intervention.

Fine needle aspiration cytology of basal cell adenoma of the salivary gland: a cytohistological correlation study of 35 cases

OBJECTIVE

In order to evaluate the possibility of a specific cytological recognition of basal cell adenoma (BCA) we reviewed our experience with 35 histologically proven cases. Few series describing cytological features of BCA are available and diagnostic cytological criteria are not well established.

METHODS

This study was based on 41 cytology samples from 35 patients with BCA. Thirty-five aspiration procedures were performed pre-operatively and six on tumour recurrence. Nineteen of the 35 patients were men and 16 women. The mean age at diagnosis was 55 years old (range 24-92). The series includes one non-representative case. Except for one tumour located in the upper lip, all of them involved the parotid gland.

RESULTS

Aspirates were cellular, showing groups with dense, homogeneous metachromatic stroma and single cells. Relevant features were the trident-like configuration of groups, intimate relationship between neoplastic cells and stroma and cellular polymorphism. In approximately half of the cases a precise diagnosis was given. Most of the remaining tumours were diagnosed as benign but they were difficult to differentiate from pleomorphic adenoma. Regarding malignancy, there were two misdiagnoses of acinic cell carcinoma, due to high epithelial cellularity along with scarcity of stroma, and one case was considered to be suspicious of malignancy.

CONCLUSION

BCA shows characteristic cytological features that allow a precise diagnosis. The main differential diagnosis is epithelial-rich pleomorphic adenoma, while acinic cell carcinoma is a potential false positive.

Comparative cytologic and histologic study of fifteen salivary basal-cell tumors: differential diagnostic considerations

Cytologic results of preoperative fine-needle sampling (FNS) of 15 salivary basal-cell tumors are presented, described, and compared with histologic results. Eleven of the FNAS showed individual and clusters of homogeneous basaloid cells with scanty cytoplasm, occasional peripheral palisading, and naked nuclei and were diagnosed as basal-cell adenoma. Four samples showed, in addition, three-dimensional cell clusters with mild cytonuclear atypia, occasional mitosis, and/or focal necrosis and were diagnosed as basal-cell adenocarcinoma. Basal-cell tumors must be diagnostically differentiated from adenoid cystic carcinoma and metastatic basal-cell carcinoma. Although the adenomas diagnosed by cytologic examination and four suspected carcinomas in our series were verified by histologic testing, the bland cytologic features of basal-cell adenocarcinoma may not always allow diagnosis on cytologic examination.

Salivary gland neoplasms with basaloid cell features: report of two cases diagnosed by fine-needle aspiration cytology

Basal-cell adenoma and basal-cell adenocarcinoma of the salivary gland are rare tumors. Fine-needle aspiration cytology of these tumors, particularly those of basal-cell adenocarcinoma, has rarely been described in the literature. In this report, we describe the clinical, cytomorphologic, histopathologic, and immunohistochemical features of basal-cell adenoma and its malignant counterpart, basal-cell adenocarcinoma, in 2 patients. Fine-needle aspiration specimens from both tumors contained abundant cohesive groups of neoplastic cells. Basaloid cells were prominent in both tumors; however, there were significant cytologic atypia, hyperchromasia, and increased nuclear-to-cytoplasmic ratio in basal-cell adenocarcinoma. Review of the literature and cytomorphologic distinction between both tumors and others are discussed.

Basal cell carcinoma metastatic to the salivary glands: differential diagnosis in fine-needle aspiration cytology

A disparate group of salivary gland neoplasms is characterized by small, uniform, hyperchromatic, basaloid cells. This "small blue cell" pattern is most common in non-Warthin's types of monomorphic adenoma, or in adenoid cystic carcinoma. Small cell anaplastic carcinoma (primary or metastatic), metastatic basaloid squamous cell carcinoma, basal cell adenocarcinoma, and metastatic nasopharyngeal carcinoma are rarely encountered but may present a cytologically similar appearance. We report one female and two male patients (median age = 84 yr) with cutaneous-type basal cell carcinoma (BCC) aspirated from metastatic deposits in the parotid (2 cases) or the submandibular (1 case) gland. One was correctly classified at the time of aspiration, based on a previous history of multiple facial BCC. One was interpreted as carcinoma, the previous history being unavailable at the time of FNA. Smears in these two cases show necrosis and rare keratotic cells. The third cases was mistaken for pleomorphic adenoma (PA); the smears showed metachromatic fragments of collagenous tumor stroma that were misinterpreted as the matrix material typical PA. Similar material was identified in the other two cases. When the "small blue cell" pattern is encountered in salivary bland cytology, one should consider BCC, especially if necrosis is identified. The desmoplastic tumor stroma of BCC may mimic the chondroid matrix of PA. Careful consideration of previous history is very important.

Primary and metastatic high-grade carcinomas of the salivary glands: a cytologic-histologic correlation study of twenty cases

We reviewed the clinical and fine-needle aspiration (FNA) findings in 20 patients with poorly differentiated carcinomas presenting initially as parotid or as submandibular masses. There were 11 primary tumors and nine metastatic malignancies in 14 males and six females ranging in age from 39 to 89 yr (median = 66). The tumor types included three primary carcinomas with oncocytic features, three additional cases of high-grade parotid carcinoma, one case of primary neuroendocrine carcinoma, two examples of malignant mixed tumor, one high-grade mucoepidermoid carcinoma, and a single example of malignant lymphoepithelial lesion. Six patients with metastatic carcinoma had previous diagnoses of malignancy. In the three remaining individuals, primary carcinomas of the lung (two cases), and an unknown primary site presented initially as parotid masses. Five examples of metastatic squamous cell carcinoma, one metastatic basal cell carcinoma, and two metastatic renal cell carcinomas were identified. One parotid lymphoepithelioma was interpreted cytologically as an atypical lymphoproliferative process suggestive of Hodgkin's disease. Nineteen cases (95%) were correctly classified as carcinoma at the time of FNA. High-grade carcinomas aspirated from the parotid may be primary, but are frequently metastatic to either the gland, or to an intraparotid lymph node. Our experience indicates that some metastatic carcinomas present at this site, without a previous history of malignancy. Distinguishing primary from metastatic lesions has important therapeutic implications.

Coexpression of vimentin, cytokeratin and S-100 in monomorphic adenoma of salivary gland; value of marker studies in the differential diagnosis of salivary gland tumours

An unusual coexpression of glial fibrillary acid protein (GFAP), keratin and vimentin occurs in pleomorphic adenoma of salivary gland. We designed this study to see if coexpression of the markers was also present in monomorphic adenoma of the salivary gland and whether monomorphic adenoma could be distinguished from other salivary gland tumours by marker studies. Immunocytochemical markers were used on fine needle aspiration samples from four cases of monomorphic adenoma, two cases of oncocytic adenoma, three cases of adenoid cystic carcinoma and four cases of pleomorphic adenoma. While positivity for cytokeratin, vimentin and S-100 was consistently found in all cases of monomorphic adenoma, only cytokeratin was expressed in adenoid cystic carcinoma. In pleomorphic adenoma, GFAP, cytokeratin and vimentin were coexpressed while in cases of oncocytic adenoma none of the markers was localized. Thus, it appears that by using a combination of GFAP, cytokeratin, vimentin and S-100 a distinction between these neoplasms may be possible. However, a larger study is needed to establish the usefulness of this approach.

Monomorphic adenomas of the major salivary glands: clinicopathological study of 44 cases

We report 44 cases of monomorphic adenoma (MA) of the major salivary glands observed during the years 1979-1989. All of these tumours were reviewed and classified on the basis of the World Health Organisation (WHO) criteria. Histological type, site, sex and age were considered. 34 cases of adenolymphoma were observed, all of them located in the parotid glands; 10 MA without lymphoid stroma were located in both parotid and submandibular glands. Distinctive histological and clinico-pathological features of the latter group of tumours are discussed, as well as the diagnostic criteria in distinguishing these tumours from pleomorphic adenoma and adenoid-cystic carcinoma.

Fine-needle aspiration of parotid tumors

We evaluated the accuracy and usefulness of fine-needle aspiration cytologic evaluation of intraparotid masses in 64 patients who underwent subsequent surgery. Adequate specimens for cytologic evaluation were obtained in 46 of the 64 patients (72 percent). Thirty-three lesions in this group (72 percent) were benign and 13 (28 percent) were malignant. There was agreement of cytologic with final histologic diagnosis with regard to distinction of malignant from benign lesions in 43 of the 46 cases (93 percent). Eleven of 13 malignant tumors (sensitivity 85 percent) and 32 of 33 benign lesions (specificity 97 percent) were predicted. Exact tissue diagnosis was correctly determined in 34 of the 46 tumors (74 percent). There were no instances of hematoma, infection, facial nerve injury, implantation of tumor, or other complications as a result of 71 aspirations performed in 64 patients. Information gained by fine-needle aspiration was often valuable in assessing the suitability and extent of surgical treatment.