Sebaceous lymphadenoma 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.

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.

Sebaceous lymphadenoma requiring superficial parotidectomy

An 82-year-old woman presented with a painless, progressively enlarging right neck mass of 2 years' duration. CT with contrast showed a 5.0 cm confluence of nodes just inferior to the right parotid gland. Fine-needle aspiration showed a lymphoproliferative disorder. Incisional biopsy showed sebaceous lymphadenoma. She subsequently underwent superficial right parotidectomy with neck dissection of level II-V (performed for enlarged lymph nodes causing significant pain). Facial nerve was preserved. She remained free of disease nearly 1 year postoperatively.

Sebaceous Lymphadenoma of Parotid: Imaging, Cytological, and Histological Findings in Detail

Sebaceous lymphadenomas are rare and account for less than 1% of primary salivary gland tumors. These rare tumors are mostly found in men older than 50 years. The clinicopathological features of these tumors are poorly understood and no definite causative factor has been reported for them till now. They are not often diagnosed prior to surgery, which could be due to their rarity and lack of enough preop radiological and cytological findings. Few case reports have been published in literature about their pathogenesis and accompanying malignant lesions. The cytological and imaging findings have been dealt with in some articles. Here we describe the histologic, cytologic, and radiologic findings of sebaceous lymphadenomas of parotid gland, all together, and discuss their differential diagnoses in various diagnostic methods.

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.

My journey into the world of salivary gland sebaceous neoplasms

As part of this symposium honoring Leon Barnes, the authors were asked to present the case from which they learned the most. I chose a cystic sebaceous lymphadenoma (SL) as my case presentation. This paper presents this unusual case, as well as several additional sebaceous tumors that came across my desk the first few years I was in practice. These interesting cases led me to thoroughly review the literature on sebaceous tumors of the salivary glands, resulting in several publications, the largest series of sebaceous tumors published at this time as well as a careful review of all cases in the literature. The author will also review the current and previous literature on the five types of salivary gland sebaceous tumors: sebaceous adenoma, SL (and non-sebaceous lymphadenoma), sebaceous carcinoma, sebaceous lymphadenocarcinoma, and sebaceous differentiation in other types of salivary gland lesions.

A red cheek as first clinical sign of a sebaceous lymphadenocarcinoma of the parotid gland with lymphangiosis carcinomatosa and lymph node metastases

Sebaceous lymphadenoma is a rare benign neoplasm presenting predominantly in the parotid gland or in periparotid lymph nodes. It rarely transforms into a malignant tumor. We present a sebaceous lymphadenoma with an unusual clinical presentation with a malignant component, infiltration of lymph nodes, and lymphangiosis carcinomatosa. Sebaceous lymphadenoma usually presents as a well-circumscribed, painless, infraauricular mass. In our 87-years-old male patient, the clinical presentation was confluent reddish livid plaques at the left cheek and the left neck. In addition, cervical lymph node metastases were suspected. After skin biopsy, the tumor was excised by parotidectomy, skin excision, and neck dissection followed by a postoperative radiotherapy. To our knowledge, this is the sixth reported case of sebaceous lymphadenocarcinoma and the first case presenting with cervical lymph node metastases and dermatological symptoms revealing lymphangiosis carcinomatosa.

Sebaceous lymphadenoma: a case report and review of the literature

An 80-year-old woman presented with a mass in her left parotid region. An ultrasound-guided core biopsy showed sebaceous glands with lymphoplasmacytic infiltration. Magnetic resonance imaging displayed a well-circumscribed lesion within the left parotid gland. The mass was completely excised, and the patient made a full recovery. Sebaceous lymphadenomas of the salivary glands are rare, benign tumors that are effectively treated by complete excision. The challenge that these tumors present lies in their accurate diagnosis. Because of their histologic similarity to related malignant tumors, such as mucoepidermoid carcinomas and sebaceous lymphadenocarcinomas, misdiagnosis could lead to unnecessarily radical treatment. We highlight the need for careful clinical and histologic diagnosis in tumors of the salivary glands.

Sebaceous lymphadenoma demonstrated by CT and MRI

Sebaceous differentiation in normal salivary gland tissue is known to occur, but primary sebaceous neoplasms of the salivary gland are extremely rare. To the best of our knowledge, very few studies have described thin-section computed tomography (CT) and magnetic resonance (MR) imaging results in patients with sebaceous lymphadenomas. We describe a 75-year-old man with a sebaceous lymphadenoma of the right salivary gland. Thin-section CT images revealed a well-defined, inhomogeneous, low-density mass with scattered fat density areas, whereas dynamic MR images revealed a mass with fat intensity areas with an early enhanced and delayed washout pattern and an enhanced capsule.