Histologic Changes Induced by Fine-Needle Aspiration

Submandibular Gland Oncocytoma: A Rare Tumor Case Series-Its Diagnosis and Treatment Based on Clinicopathology

Aim and Objective

Submandibular oncocytomas are rare benign salivary gland neoplasms, normally involves the parotid gland and few instances are stated in the submandibular gland region. As the clinical and histopathological features are overlapping to another salivary gland tumor like pleomorphic adenoma or warthin tumour, they are often misdiagnosed. They are typically found in patients aged 50-70 years with no gender preference. The aim of this paper is to assess the clinicopathological functions, diagnostic standards and treatment of submandibular gland oncocytomas via a series of three case reports.

Method and Results

We report a three case series of unilateral submandibular gland oncocytoma with female to male ratio 2:1, Size of tumor ranged from 1.8 to 10 cm, 2 cases have painless swelling and one involved tender mass. FNAC and CT scan confirmed the presence of an oncocytoma. The patient underwent unilateral submandibular gland resection and on follow up no evidence of any recurrence was identified.

Conclusion

Submandibular oncocytomas often present as solitary slow growing painless masses, which are firm on clinical examination. CT followed by fine-needle aspiration cytology (FNAC) would be the preferred diagnostic modalities. Due to its low rate of malignant transformation and recurrence, the best treatment is local resection with follow-up as necessary.

[Usefulness of antimitochondrial antibody 113-1 in diagnosis and classification of salivary gland tumours with oncocytic differentiation]

INTRODUCTION AND OBJECTIVES

Salivary gland tumours usually show great variability both in their morphopathology as well as their clinical behaviour. In the present study, the usefulness of antimitochondrial monoclonal antibody 113-1 in the diagnosis and categorization of salivary tumours was studied.

MATERIAL AND METHODS

A series of 22 benign and malignant salivary tumours and 5 non-tumoral salivary gland specimens were immunohistochemically analysed using an antimitochondrial monoclonal antibody (Ab Mo 113-1), which recognises a non-glycosylated mitochondrial protein of 60 Kd.

RESULTS

The use of this antibody allowed us to recognize all salivary tumours with oncocytic differentiation. Two salivary tumours (1 papillary cystadenoma and 1 epithelial-myoepithelial carcinoma) (2/22; 10%) were also reclassified as oncocytic tumoral subtypes, in principle unidentified.

CONCLUSION

Our study highlights the usefulness of this antibody to facilitate the classification of salivary tumours, an aspect that may sometimes have not only diagnostic implications, but also prognostic.

Nodular spindle cell proliferation in the wall of a varicose vein mimicking Kaposi's sarcoma

Exuberant reparative reactions resembling sarcoma have been reported in the genitourinary tract, thyroid, breast, lymph node, oral cavity and skin, but not in a varicose vein. Presented herein is the case of a 55-year-old man who showed an incidental nodular lesion in the wall of a varicose vein on the left leg. The nodule consisted of fascicles of spindled cells with ovoid or elongated nuclei and delicate chromatin that showed diffuse reactivity for CD31, alpha-smooth muscle actin and D2-40. This histopathological appearance, when coupled with extravasated erythrocytes and interstitial hemosiderin deposits, resembled Kaposi's sarcoma or spindle cell angiosarcoma. Key features helpful for recognizing that the proliferation we describe is a form of tissue repair include an association with obvious hemorrhage; lack of well-formed curved fascicles of spindled cells; lack of intracytoplasmic hyaline globules; lack of intracellular vacuolization; cytological blandness; low mitotic count; absence of inmmunoreactivity for human herpesvirus-8 (HHV-8) latent nuclear antigen-1; and absence of HHV-8 in polymerase chain reaction (PCR) analysis.

Histological alterations following thyroid fine needle biopsy: a systematic review

Thyroid fine-needle biopsy (FNB) is a simple, reliable, inexpensive, and generally safe diagnostic procedure in the management of thyroid nodules. However, the trauma inflicted by the needle may lead to various degrees of histological alterations, observed in histological specimens, if thyroidectomy follows. Post-FNB histological alterations of the thyroid (PFHAT) can generally be divided into acute and chronic. Hemorrhage is the most common acute and fibrosis the most common chronic PFHAT. Some of the PFHAT causes problems in histological assessment, making diagnosis difficult, even leading to misdiagnosis. In this review, we tried to collect and summarize all reported PFHAT cases and studies, aiming to make involved physicians, cytologists, and pathologists aware of the spectrum of PFHAT and to provide information to help in differential diagnosis and to avoid misdiagnoses, which could lead to unnecessary radical surgery and/or adjuvant therapy.

Capsular intravascular endothelial hyperplasia: a peculiar form of vasoproliferative lesion associated with thyroid carcinoma

AIMS

Florid vasoproliferative processes are uncommon in the thyroid gland. We report three cases of an unusual vasoproliferation involving the capsular blood vessels of thyroid carcinoma.

METHODS AND RESULTS

The histological diagnoses of the three cases were made on conventional histological sections. Two cases were minimally invasive follicular carcinomas and one case was an encapsulated variant of papillary carcinoma. Some blood vessels in the tumour fibrous capsule were filled with spindly cellular proliferations forming irregular vascular clefts and papillae. Immunohistochemical studies for CD31, CD34 and muscle-specific actin confirmed that the spindly cells were mostly endothelial cells variably supported by pericytes.

CONCLUSION

This peculiar intravascular endothelial hyperplasia by itself should not be mistaken for vascular invasion by tumour, but evidence of malignancy must be diligently sought by extensive sampling because the lesion has thus far been consistently associated with malignant thyroid neoplasms.

Cytopathology of papillary oncocytic carcinoma of the thyroid in fine-needle aspiration biopsy

The fine-needle aspirates from two histologically, immunohistochemically, and ultrastructurally confirmed encapsulated papillary oncocytic carcinoma of the thyroid revealed large and small papillary tumor tissue fragments consisting of fibrovascular cores covered with polygonal cells showing abundant and granular cytoplasm and small, oval nuclei. Abundant single and loosely clustered tumor cells with similar cytologic features were also present. Nuclear pleomorphism, irregular nuclear contours, nuclear grooves, and intranuclear cytoplasmic inclusions were not observed in any tumor cells. The two patients were alive and well and showed no evidence of tumor recurrence and/or metastatic disease 6 and 8 years after their thyroid surgeries, respectively.

Tissue effects of salivary gland fine-needle aspiration. Does this procedure preclude accurate histologic diagnosis?

Recent reports have alluded to various tissue effects secondary to fine-needle aspiration (FNA), particularly infarction observed in resected salivary gland masses, precluding accurate histologic diagnosis. Our experience with the use of 25-gauge needles indicates otherwise. We retrospectively reviewed 94 resected salivary gland masses previously sampled by FNA, looking for infarction, hemorrhage, needle track tumor seeding, and fibrosis. We assessed the significance of these complications and their impact on the histologic diagnosis. The median interval from FNA to excision was 25 days. Variable degrees of infarction and hemorrhage were present in 7 cases (7%) and 9 cases (10%), respectively. Infarction ranged from 5% to 80% (average, 20%), while hemorrhage averaged less than 20% of the material on the tissue sections. Significant infarction was present in acinic cell carcinomas (3/7), but histologic diagnosis was not compromised, and tissue alterations were absent. We conclude that FNA of salivary gland lesions using 25-gauge needles is safe and does not significantly alter the histologic diagnosis. The tissue effects observed did not preclude accurate diagnostic interpretation in any case.

Metaplastic (infarcted) Warthin's tumour of the parotid gland: a possible consequence of fine needle aspiration biopsy

AIMS

The metaplastic (or infarcted) variant of Warthin's tumour is characterized by replacement of much of the original oncocytic epithelium by metaplastic squamous cells, along with areas of extensive necrosis, fibrosis and inflammatory change. The pathogenesis is unknown, but it is most likely to be vascular in origin. An association with a previous fine needle aspiration (FNA) has been suggested, and this is explored further.

METHODS AND RESULTS

Nine metaplastic Warthin's tumours were collected from several centres: all arose in the parotid gland, and all showed the characteristic histological features. Eight had previously undergone FNA some 1-4 months before surgery; the other case had had an incisional biopsy.

CONCLUSIONS

It is important to recognize metaplastic Warthin's tumour, because the differential diagnoses of this benign neoplasm include mucoepidermoid and squamous carcinoma, both primary and metastatic. The tumours in this study followed FNA or biopsy, and we believe this association is unlikely to be coincidental. Although many metaplastic Warthin's tumours clearly arise spontaneously, we conclude that the balance of probabilities favours the view that FNA is capable of causing metaplastic change in a Warthin's tumour, and may have done so in these cases. If so, this previously unusual subtype will become increasingly common, as FNA becomes more widely used (and its value appreciated) in the investigation of patients with a mass in the neck.

Malignancy-simulating change in parotid gland oncocytoma following fine needle aspiration. Report of 3 cases

We report here there cases of benign parotid gland oncocytoma with pseudomalignant change that mimic acinic cell carcinoma. All patients underwent fine-needle aspiration biopsy of the tumor 62, 725 and 33 days before surgical excision. In histologic sections, there were clusters of pigmented cells with PAS-positive foamy to finely granular cytoplasm similar to those seen in salivary gland acinic cell carcinomas. This report provides another, previously undescribed, example of a diagnostic pitfall that may be observed in histologic tissue specimens removed after FNA of oncocytic tumors.

Capsular pseudoinvasion after fine-needle aspiration of follicular adenomas of the thyroid

Two cases of an unusual finding of capsular pseudoinvasion in follicular thyroid adenomas after fine-needle aspiration (FNA) procedures are reported. These capsular breaches were noted along the hemorrhagic needle track, which traversed the normal peripheral thyroid parenchyma into the lesions. A reparative reaction was seen at some points along one of the tracks. Histologic examination also showed extrusion of the tumor parenchyma through the capsular interruption in one case. Surgical pathologists should be aware of this rare complication of FNA of thyroid follicular adenomas as a differential diagnosis of minimally invasive (encapsulated) follicular carcinoma.

Oncocytomas of the submandibular gland. A series of 22 cases and a review of the literature

BACKGROUND

Oncocytomas are benign salivary gland neoplasms that represent approximately 1.5% of all salivary gland tumors. Oncocytomas of the submandibular gland, however, are decidedly uncommon.

METHODS

Twenty-two cases of submandibular gland oncocytomas from the files of the Oral and Otolaryngic Tumor Registries of the Armed Forces Institute of Pathology were reviewed, and analysis of the histologic criteria, histochemical and immunohistochemical reactions, and ultrastructural and clinical follow-up data was performed.

RESULTS

The patients included 11 females and 11 males, age 21-88 years, with a mean age at presentation of 58.7 years. Clinically, the tumors were generally asymptomatic masses in the submandibular gland that increased in size over a period ranging from several weeks to 20 years and were occasionally associated with pain (n = 9). The tumors ranged in greatest dimension from 0.7 to 7 cm and were circumscribed to encapsulated. Histologically, the tumors were characterized by large epithelial cells with eosinophilic, granular cytoplasm. The cytoplasm stained positively with stains used to demonstrate mitochondria (phosphotungstic acid-hematoxylin, Novelli, Cresylecht violet V, and Kluver-Barrera Luxol fast blue stains). Immunohistochemical reactions demonstrated an epithelial origin (keratin and epithelial membrane antigen), whereas markers for myoepithelial derivation (S-100 protein, actin, and glial fibrillary acidic protein) were not identified. At the time this study was conducted, all patients with submandibular oncocytomas were either alive without evidence of disease or had died without evidence of recurrent disease, with surgical resection the only treatment.

CONCLUSIONS

Submandibular gland oncocytomas are rare, benign tumors. The tumor cells are filled with mitochondria, which are easily demonstrated by histochemical reactions. Complete surgical resection is adequate therapy.