1
|
Oh KY, Hong SD. Infarction of basal cell adenoma of the parotid gland: First case report and literature review on CTNNB1 I35T mutations in salivary basal cell neoplasms. Oral Oncol 2023; 145:106534. [PMID: 37517215 DOI: 10.1016/j.oraloncology.2023.106534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
Infarction has rarely been reported in some types of salivary gland tumors. In this study, we present the first case of infarction occurring in salivary basal cell adenoma. A 62-year-old male presented with swelling in the left parotid region. Histopathological examination revealed extensive central necrosis surrounded by a rim of viable tumor tissue showing the typical histology of basal cell adenoma. Nuclear β-catenin expression and the CTNNB1 p.I35T (c.104 T > C) mutation were identified in the tumor. A diagnosis of basal cell adenoma with central necrosis was made, and the postoperative period was uneventful. In addition, we review the literature on CTNNB1 I35T mutations in basal cell neoplasms of the salivary glands. Awareness of the possible occurrence of infarction and the high frequency of the unique mutation in basal cell adenoma may help in the differential diagnosis of salivary gland tumors.
Collapse
Affiliation(s)
- Kyu-Young Oh
- Department of Oral Pathology, College of Dentistry, Dankook University, Cheonan, Republic of Korea; Department of Oral Pathology, Seoul National University Dental Hospital, Seoul, Republic of Korea.
| | - Seong-Doo Hong
- Department of Oral Pathology, Seoul National University Dental Hospital, Seoul, Republic of Korea; Department of Oral Pathology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea.
| |
Collapse
|
2
|
Almasri B, Gustafson KS, Husson MA, Shanti RM, France K. Asymptomatic bilateral facial swelling. J Am Dent Assoc 2023; 154:260-265. [PMID: 35341561 DOI: 10.1016/j.adaj.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/19/2022]
|
3
|
Hindi I, Simsir A, Szeto O, Hernandez O, Sun W, Zhou F, Brandler TC. The Milan System for Reporting Salivary Gland Cytopathology. Am J Clin Pathol 2022; 158:583-597. [PMID: 35849113 DOI: 10.1093/ajcp/aqac075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/11/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Our study assesses whether the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) offers any benefit over the original cytology classification, and measures interobserver agreement. METHODS Four cytopathologists retrospectively blindly classified preoperative cytology by MSRSGC from 101 resected salivary tumors. Consensus MSRSGC diagnoses were correlated with surgical pathology diagnoses and compared with the original cytology classification. Diagnostic parameters were calculated for both systems. Interobserver variability was assessed. RESULTS The original cytology classification vs MSRSGC had sensitivity, specificity, positive predictive value, and negative predictive value of 75.0% vs 78.3%, 97.1% vs 98.0%, 91.2% vs 94.7%, and 90.1% vs 90.0%, respectively. The original cytology classification risk of neoplasm (RON) was 91.7% for "negative for malignancy" and 100.0% for other categories. The MSRSGC RON was 71.4% in category II (nonneoplastic) and 100.0% in all other categories. The original cytology classification risk of malignancy (ROM) ranged from 0.0% for "atypical" to 100.0% for "positive for malignancy." The MSRSGC ROM ranged from 0.0% in categories I (nondiagnostic) and III (nonneoplastic) to 100.0% in category VI (malignant). Weighted agreement using the MSRSGC was 92% (Gwet AC1, 0.84); unweighted agreement was 69% (Gwet AC1, 0.64). MSRSGC category IVA (benign neoplasm) was most likely to show interobserver agreement, with complete agreement in 67% of cases. CONCLUSIONS The MSRSGC performs similarly to the original cytology classification and shows relatively high interobserver agreement.
Collapse
Affiliation(s)
- Issa Hindi
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Aylin Simsir
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Oliver Szeto
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Osvaldo Hernandez
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Wei Sun
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Fang Zhou
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Tamar C Brandler
- Department of Pathology, New York University Langone Health, New York, NY, USA
| |
Collapse
|
4
|
Vahdani K, Luthert PJ, Rose GE. Chronic Granulomatous Dacryoadenitis Associated With Pleomorphic Adenoma. Ophthalmic Plast Reconstr Surg 2022; 38:e54-e57. [PMID: 34812181 DOI: 10.1097/iop.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic granulomatous inflammation occurs rarely alongside pleomorphic adenomas of the major salivary glands but would not appear to have been reported with lacrimal gland adenomas. We describe the clinical features, imaging and histopathology for 4 patients (3 female) who had granulomatous inflammation alongside lacrimal gland adenomas-the patients being with age 39, 44, 48, and 53 years at time of surgery. One patient had an asymptomatic lesion found on imaging, and the other 3 had symptoms for between 3 years and several decades. Conjecturally, this rare phenomenon might arise from an inflammatory response to leakage of secretions from the ductular components of the glands.
Collapse
Affiliation(s)
- Kaveh Vahdani
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
| | - Philip J Luthert
- University College London (UCL) Institute of Ophthalmology, London, United Kingdom
| | - Geoffrey E Rose
- Adnexal Service, Moorfields Eye Hospital, London, United Kingdom
- University College London (UCL) Institute of Ophthalmology, London, United Kingdom
| |
Collapse
|
5
|
Li JJX, Ng JKM, Lau EHL, Chan ABW. Aspiration cytology of pleomorphic adenoma with squamous metaplasia: A case series and literature review illustrating diagnostic challenges. Diagn Cytopathol 2021; 50:64-74. [DOI: 10.1002/dc.24915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Joshua J. X. Li
- Department of Anatomical and Cellular Pathology Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Joanna K. M. Ng
- Department of Anatomical and Cellular Pathology Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Eric H. L. Lau
- Department of Otorhinolaryngology Head and Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Amy B. W. Chan
- Department of Anatomical and Cellular Pathology Prince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| |
Collapse
|
6
|
Hernandez-Prera JC, Skálová A, Franchi A, Rinaldo A, Vander Poorten V, Zbären P, Ferlito A, Wenig BM. Pleomorphic adenoma: the great mimicker of malignancy. Histopathology 2021; 79:279-290. [PMID: 33368685 DOI: 10.1111/his.14322] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022]
Abstract
Pleomorphic adenoma (PA) is the most common salivary gland neoplasm, and its diagnosis is straightforward in the majority of cases. However, not infrequently, PA shows unusual and uncommon histological features that can be confused with those of malignancy. The difficulties in diagnosing PA arise from its ability to mimic invasion, show atypical or metaplastic cytomorphology, and show morphological features that overlap with those of established salivary gland carcinomas. In addition, recognising early malignant transformation to carcinoma ex-pleomorphic adenoma continues to be a frequent challenge. This review describes the diagnostic pitfalls of PA, and offers a systematic approach to avoid them by combining classic histopathology with novel immunohistochemical and molecular tests.
Collapse
Affiliation(s)
| | - Alena Skálová
- Department of Pathology, Faculty of Medicine in Plzen, Charles University, Plzen, Czech Republic
| | - Alessandro Franchi
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Vincent Vander Poorten
- Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.,Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Peter Zbären
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital, Bern, Switzerland
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| | - Bruce M Wenig
- Department of Pathology, Moffitt Cancer Center, Tampa, FL, USA
| |
Collapse
|
7
|
Ito H, Ishida M, Okano K, Sandoh K, Ebisu Y, Yoshioka S, Fujisawa T, Iwai H, Tsuta K. Spontaneous infarction of pleomorphic adenoma of the parotid gland: A case report. Mol Clin Oncol 2020; 13:68. [PMID: 33014367 PMCID: PMC7520748 DOI: 10.3892/mco.2020.2138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/21/2020] [Indexed: 11/05/2022] Open
Abstract
Infarction after the fine-needle aspiration (FNA) procedure is a well-recognized phenomenon of salivary gland lesions. Though extremely rare, spontaneous infarction without previous FNA can occur in pleomorphic adenoma (PA). The present report describes a fourth cytological case of spontaneous infarction of PA of the parotid gland using immunocytochemical analysis, to the best of our knowledge, for the first time. A 57-year-old Japanese female presented with persistent swelling of the right neck region. Physical examination revealed a tumour in the right parotid gland, and FNA examination of the tumour was performed following surgical resection. The Papanicolaou smear demonstrated the presence of fully necrotic cell clusters of varying sizes in a necrotic background. Only a few viable cell clusters were observed. These cells were polygonal to spindle-shaped, and exhibited large round to oval nuclei with a conspicuous nucleoli. Although nuclear pleomorphism was noted, the nuclear chromatin was fine. No neoplastic myoepithelial cells were observed. Therefore, it was suspected that these cells were malignant. Immunocytochemical analysis indicated that these atypical cells were positive for p40. Histopathological examination of the resected parotid gland tumour revealed infarcted PA. Our study revealed that the presence of atypical squamous metaplastic cells in a necrotic background was a characteristic cytological feature of infarcted PA, and that these atypical squamous cells can have large nuclei with conspicuous nucleoli and exhibit pleomorphism. Although cytological diagnosis of infarcted PA is difficult, pathologists and cytopathologists must consider the presence of atypical metaplastic squamous cells in benign salivary gland tumours, including infarcted PA.
Collapse
Affiliation(s)
- Hiroko Ito
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, 573-1010 Osaka, Japan
| | - Mitsuaki Ishida
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, 573-1010 Osaka, Japan
| | - Kimiaki Okano
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, 573-1010 Osaka, Japan
| | - Kaori Sandoh
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, 573-1010 Osaka, Japan
| | - Yusuke Ebisu
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, 573-1010 Osaka, Japan
| | - Saya Yoshioka
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, 573-1010 Osaka, Japan
| | - Takuo Fujisawa
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, 573-1010 Osaka, Japan
| | - Hiroshi Iwai
- Department of Otolaryngology, Kansai Medical University, Hirakata, 573-1010 Osaka, Japan
| | - Koji Tsuta
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Hirakata, 573-1010 Osaka, Japan
| |
Collapse
|
8
|
Pujani M, Sidam D, Singh K, Khandelwal A, Katarya K. Xanthogranulomatous change in a pleomorphic adenoma: An extremely rare variant/degenerative change. Is it fine needle aspiration induced? Diagn Cytopathol 2020; 49:E71-E74. [PMID: 32822112 DOI: 10.1002/dc.24585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/22/2020] [Accepted: 08/03/2020] [Indexed: 11/07/2022]
Abstract
Pleomorphic adenoma (PA) is the most common benign salivary gland tumor characterized by morphological diversity, metaplastic changes, degeneration, cystic change, altered differentiation, and rarely malignant transformation, thereby may create a diagnostic dilemma on cytology. Xanthogranulomatous (XG) inflammation within a PA could be due to XG sialadenitis coexistent with PA or preoperative fine-needle aspiration cytology (FNAC) induced histologic alteration. The argument in favor of this hypothesis is that the changes seen in the histopathology would not be present in the cytology, implying that the alterations were most likely due to the traumatic injury of needling rather than spontaneous change of the lesions themselves. These FNAC induced changes are focal in most of the cases, so the underlying lesion is readily identifiable, but on rare occasions they are so extensive that it can masquerade as a malignancy. We report a case of XG change in a PA in a 39-year-old male of 8 years standing. Through this case we wish to emphasize that knowledge of a previous FNAC and its potential effects on histology of the subsequent surgical specimen is necessary to avoid potential misdiagnosis.
Collapse
Affiliation(s)
- Mukta Pujani
- Department of Pathology, ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Dipti Sidam
- Department of Pathology, ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Kanika Singh
- Department of Pathology, ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Aparna Khandelwal
- Department of Pathology, ESIC Medical College & Hospital, Faridabad, Haryana, India
| | - Khushbu Katarya
- Department of Pathology, ESIC Medical College & Hospital, Faridabad, Haryana, India
| |
Collapse
|
9
|
Iftikhar H, Sohail Awan M, Usman M, Khoja A, Khan W. Discordance between fine-needle aspiration cytology and histopathology in patients with mucoepidermoid carcinoma of parotid gland. Ann R Coll Surg Engl 2020; 102:340-342. [PMID: 32159383 DOI: 10.1308/rcsann.2020.0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Fine-needle aspiration cytology (FNAC) is an important diagnostic tool used preoperatively for the diagnosis of parotid lump. Mucoepidermoid carcinoma comprises 5-10% of all salivary gland tumours. It poses a diagnostic challenge on FNAC with high false negative rate. The objective of this study was to evaluate the discordance between cytology/FNAC and histopathology in patients with mucoepidermoid carcinoma. MATERIAL AND METHODS A cross-sectional study was conducted from 1 January 2010 to 31 December 2014. Patients aged 18 years and above with FNAC or histopathology suggestive of mucoepidermoid carcinoma were identified. FNAC when compared with histology (gold standard) was classified into true positive (presence of mucoepidermoid carcinoma correctly diagnosed on FNAC), true negative (absence of mucoepidermoid carcinoma correctly diagnosed on FNAC), false positive (FNAC incorrectly diagnosed mucoepidermoid carcinoma), false negative (FNAC failed to diagnose mucoepidermoid carcinoma). RESULTS A total of 16 patients fulfilled our eligibility criteria. Seven cytological samples were true positive (ie correctly diagnosed mucoepidermoid carcinoma by FNAC), eight cytological specimens were false negative (ie could not pick up mucoepidermoid carcinoma on FNAC). One case was false positive on cytology (ie diagnosed mucoepidermoid carcinoma on FNAC but was reported to be Warthin's tumour on histopathology) and none were true negative. CONCLUSION FNAC is not reliable for diagnosis of mucoepidermoid carcinoma. More than 50% of our patients had discordant results between cytology and histology. We recommend a high index of suspicion for mucoepidermoid carcinoma given the poor yield of cytology.
Collapse
Affiliation(s)
- H Iftikhar
- Department of Otolaryngology/Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - M Sohail Awan
- Department of Otolaryngology/Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - M Usman
- Department of Pathology, Aga Khan University Hospital, Karachi, Pakistan
| | - A Khoja
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - W Khan
- PNS Shifa Hospital, Karachi, Pakistan
| |
Collapse
|
10
|
Kashiwagi N, Hyodo T, Ishi K, Maenishi O, Enoki E, Chikugo T, Masakatsu T, Yagyu Y, Kitano M, Tomiyama N. Spontaneously infarcted parotid tumours: MRI findings. Dentomaxillofac Radiol 2019; 48:20180382. [PMID: 30706736 DOI: 10.1259/dmfr.20180382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To report MRI findings of spontaneous infarction in parotid tumours. METHODS 14 patients (13 male, 1 female; mean age 73 years) with spontaneously infarcted parotid tumours were reviewed retrospectively. MR images were assessed for the location, the presence of synchronous parotid masses, margin characteristics, signal intensity on T 1 and T 2 weighted images, and internal architecture according to the distribution of T 2 signal hyperintensity. RESULTS 12 tumours were located in the parotid tail and 2 in the superficial lobe. Synchronous parotid masses were seen in four tumours, three of which were located in the ipsilateral parotid tail and one in the contralateral parotid tail. Seven tumours had well-defined margins and seven had ill-defined margins. The signal intensities on T 1 weighted images were a mixture of high and intermediate in all cases; in 11 tumours, hyperintense areas were dominant. On T 2 weighted images, all tumours also showed a mixture of high and intermediate signal intensities. Internal architectures on T 2 weighted images were mosaic hyperintensity in three tumours, central hyperintensity in five, and multiseparated hyperintensity in six. CONCLUSIONS Spontaneously infarcted parotid tumours were mostly located in the parotid tail and showed mixed signal intensities with predominant hyperintensity on T 1 weighted images. Half of the tumours had ill-defined margins, and the internal architectures varied.
Collapse
Affiliation(s)
- Nobuo Kashiwagi
- 1 Department of Radiology, Kindai University Faculty of Medicine , Osaka-sayama, Osaka , Japan
| | - Tomoko Hyodo
- 1 Department of Radiology, Kindai University Faculty of Medicine , Osaka-sayama, Osaka , Japan
| | - Kazunari Ishi
- 1 Department of Radiology, Kindai University Faculty of Medicine , Osaka-sayama, Osaka , Japan
| | - Osamu Maenishi
- 2 Department of Pathology, Kindai University Faculty of Medicine , Osaka-sayama, Osaka , Japan
| | - Eisuke Enoki
- 2 Department of Pathology, Kindai University Faculty of Medicine , Osaka-sayama, Osaka , Japan
| | - Takaaki Chikugo
- 2 Department of Pathology, Kindai University Faculty of Medicine , Osaka-sayama, Osaka , Japan
| | - Tsurusaki Masakatsu
- 1 Department of Radiology, Kindai University Faculty of Medicine , Osaka-sayama, Osaka , Japan
| | - Yukinobu Yagyu
- 1 Department of Radiology, Kindai University Faculty of Medicine , Osaka-sayama, Osaka , Japan
| | - Mutsukazu Kitano
- 3 Department of Otolaryngology, Kindai University Faculty of Medicine , Osaka-sayama, Osaka , Japan
| | - Noriyuki Tomiyama
- 4 Department of Radiology, Osaka University Graduate School of Medicine , Osaka-sayama, Osaka , Japan
| |
Collapse
|
11
|
Hang JF, Shum CH, Ali SZ, Bishop JA. Cytological features of the Warthin-like variant of salivary mucoepidermoid carcinoma. Diagn Cytopathol 2017; 45:1132-1136. [PMID: 28755513 DOI: 10.1002/dc.23785] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/05/2022]
Abstract
Warthin-like mucoepidermoid carcinoma is a recently proposed variant of musoepidermoid carcinoma. Histologically, it is characterized by its close resemblance to Warthin tumor, including dense lymphocytic infiltration, flattened intermediate epithelium resembling squamous metaplasia, and cystic change. Given its histologic similarity to Warthin tumor, confirmatory testing for MAML2 rearrangement is often required for this diagnosis. Here we present the first cytologic reports of two 53-year-old female patients with parotid masses. In both cases, the fine needle aspirations showed fragments of bland epithelium with a squamous appearance, mucinous cyst content, and focal lymphocytic background. Neither frank keratinization nor mucinous cells were identified in the smears. Fluorescence in situ hybridization (FISH) study confirmed MAML2 rearrangement on the resection specimens in both. Other cytologic differential diagnoses, including Warthin tumor with metaplasia, lymphadenoma, and lymphoepithelial cyst, were briefly discussed.
Collapse
Affiliation(s)
- Jen-Fan Hang
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Syed Z Ali
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland.,Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Justin A Bishop
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland
| |
Collapse
|
12
|
Low Grade Carcinoma Ex-Pleomorphic Adenoma: Diagnosis and Diagnostic Challenges Caused by Fine Needle Aspiration: Report of Three Cases and Review of Literature. Head Neck Pathol 2017; 12:82-88. [PMID: 28589437 PMCID: PMC5873484 DOI: 10.1007/s12105-017-0829-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/31/2017] [Indexed: 01/30/2023]
Abstract
Low grade carcinoma ex pleomorphic adenoma (LG CXPA) is a rare low grade malignant neoplasm arising from preexisting pleomorphic adenoma (PA). LG CXPA demonstrates no overt cytological atypia, and can be difficult to distinguish from cellular PA. Invasive growth is one of the hallmarks of LG CXPA, e.g., tumor extends beyond the capsule and into adjacent non-neoplastic tissue. However, it is known that capsular and vascular invasion, as well as the presence of stroma-rich PA in soft tissue without a capsule (pseudopodia) can be seen in PA. These histological findings have no prognostic significance and are not diagnostic of malignancy. In addition, recurrent PA typically presents as numerous nodules extending into soft tissue and skeletal muscle, which again are not considered malignant features. Thus, "infiltrative growth" of LG CXPA is difficult to define and diagnosis is challenging to many practicing pathologists. In this study, we report three cases of LG CXPA. We review the diagnostic criteria for LG CXPA, and discuss the diagnostic challenges caused by fine needle aspiration (FNA) changes. FNA is widely used as a cost-effective, quick and accurate method for diagnosing salivary gland lesions. Histological changes post-FNA are usually focal and mild, and are not causes of diagnostic difficulties. According to our knowledge, this is the first report of LG CXPA complicated with FNA changes.
Collapse
|
13
|
Elshafey MR, Ahmed RA, Mourad MI, Gaballah ET. The oncofetal protein IMP3 is an indicator of early recurrence and poor outcome in mucoepidermoid carcinoma of salivary glands. Cancer Biol Med 2016; 13:286-95. [PMID: 27458536 PMCID: PMC4944550 DOI: 10.20892/j.issn.2095-3941.2016.0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/25/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Mucoepidermoid carcinoma (MEC) is the most common primary malignancy of the salivary glands. Insulin-like growth factor-II mRNA-binding protein-3 (IMP3) is an important prognostic factor in some cancers and a tool that differentiates between benign and malignant pancreatic lesions. This study aimed to identify a relationship between the expression of IMP3 and the outcome of salivary gland MEC, as well as to differentiate MEC from pleomorphic adenoma (PA). METHODS Tissue specimens from 70 cases of salivary gland MEC, 40 cases of PA, and 10 cases with normal salivary gland were examined immunohistochemically for IMP3. The association among the expression of IMP3, clinicopathological characteristics and patient's survival was assessed. RESULTS IMP3 was present in 51.4% of MEC but absent in PA and normal salivary gland tissues. IMP3 expression was associated with age > 60 years, submandibular gland tumors, tumor size > 4 cm, high-grade tumors, lymph node metastasis, involvement of surgical margins, perineural invasion, distant metastasis, advanced TNM stage, tumor relapse, and death ( P<0.05). Increased expression of IMP3, tumors of the submandibular gland, and lymph node metastasis were independent prognostic factors of -free survival (DFS). In addition, IMP3 was a strong predictor of overall survival (OS) together with distant metastasis and intermediate and high-grade tumors. CONCLUSIONS IMP3 expression is highly important in evaluating the outcome of MEC. IMP3 can be used to differentiate MEC from PA of salivary glands.
Collapse
Affiliation(s)
- Mohamed R. Elshafey
- Oral Pathology Department, Faculty of Dentistry, Mansoura University, Mansoura 35516, Egypt
| | - Rehab A. Ahmed
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed I Mourad
- Oral Pathology Department, Faculty of Dentistry, Mansoura University, Mansoura 35516, Egypt
| | - Essam T. Gaballah
- Oral Pathology Department, Faculty of Dentistry, Mansoura University, Mansoura 35516, Egypt
| |
Collapse
|
14
|
Joseph TP, Joseph CP, Jayalakshmy PS, Poothiode U. Diagnostic challenges in cytology of mucoepidermoid carcinoma: Report of 6 cases with histopathological correlation. J Cytol 2015; 32:21-4. [PMID: 25948939 PMCID: PMC4408672 DOI: 10.4103/0970-9371.155226] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Mucoepidermoid carcinoma (MEC) is a malignant salivary gland neoplasm with extreme morphologic heterogeneity and hence rendering a definitive fine needle aspiration cytology (FNAC) diagnosis of this neoplasm is really challenging. The present study was undertaken to elucidate the cytological features of MEC and explore the diagnostic accuracy and pitfalls by comparing with subsequent histopathology. MATERIALS AND METHODS The present study was conducted over a period of 2 years wherein we obtained six histopathologically confirmed cases of MEC. These patients were initially subjected to FNAC. The cytologic features studied included presence of mucous cells, intermediate cells, and squamous cells. Presence of background mucinous material was also noted. The cytological features were compared with the subsequent histopathology. RESULTS Of the 6 cases of MEC, a definite cytological diagnosis was possible only in 2 cases. Of the remaining 4 cases, 2 cases were broadly diagnosed in cytology as neoplasm with cystic degeneration and 2 cases were underdiagnosed as pleomorphic adenoma. CONCLUSIONS A satisfactory aspirate with all three types of cells; mucous, intermediate and squamous cells may not be obtained in all cases of MEC for providing a definite diagnosis. Hence, a good clinicoradiological correlation, a high index of suspicion and repeated aspirations especially in cystic lesions may be particularly helpful in difficult cases. In addition, while dealing with mucinous cystic lesions with low cellularity, the importance of early excision should be communicated to the clinician since the possibility of low-grade MEC cannot be excluded.
Collapse
Affiliation(s)
- Tessy P Joseph
- Department of Pathology, Government Medical College, Ernakulam, Kerala, India
| | - Cicy P Joseph
- Department of Pathology, Government Medical College, Kottayam, Kerala, India
| | - P S Jayalakshmy
- Department of Pathology, Government Medical College, Thrissur, Kerala, India
| | - Usha Poothiode
- Department of Pathology, Government Medical College, Kottayam, Kerala, India
| |
Collapse
|
15
|
Lee DH, Yoon TM, Lee JK, Lim SC. Clinical utility of fine needle aspiration cytology in pediatric parotid tumors. Int J Pediatr Otorhinolaryngol 2013; 77:1272-5. [PMID: 23726957 DOI: 10.1016/j.ijporl.2013.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/06/2013] [Accepted: 05/07/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of pediatric parotid tumors. METHODS From June 2002 to June 2012, 22 patients ≤18-years-of-age with parotid mass were treated at Chonnam National University Hospital. Included in the study were 21 cases with preoperative FNAC. A retrospective chart review analyzed the results of FNAC and compared them with the corresponding histopathological diagnosis. RESULTS Twenty-one of the 22 patients had undergone preoperative FNAC, which diagnosed pleomorphic adenoma in 13 patients. The remaining eight patients were diagnosed with benign tumor (n = 6), malignant tumor (n = 1) or Kimura disease (n = 1). All 21 patients underwent parotid tumor removal. FNAC had a diagnostic sensitivity of 92.3%, positive-predictive value of 92.3% and accuracy of 90.5% for diagnosing pleomorphic adenoma of pediatric parotid tumor. FNAC had a diagnostic sensitivity of 100%, a positive-predictive value of 85% and accuracy of 85.7% for diagnosing benign parotid tumor. CONCLUSIONS Preoperative FNAC is a useful and accurate adjunct for preoperative evaluation of pediatric parotid tumors. We recommend that preoperative FNAC should be part of the initial evaluation of pediatric patients with parotid masses.
Collapse
Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea.
| | | | | | | |
Collapse
|
16
|
A perspective of comparative salivary and breast pathology. Part I: microstructural aspects, adaptations and cellular events. Eur Arch Otorhinolaryngol 2013; 271:647-63. [PMID: 23649507 DOI: 10.1007/s00405-013-2488-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 04/08/2013] [Indexed: 10/26/2022]
Abstract
This is the first part of a review comparing the pathology of salivary and mammary glands. Here, less obvious similarities and differences in functional histology and their influences on pathology are examined with emphasis on myoepithelial cells, stromal components, analogues of mucosa-associated lymphoid tissue, steroid receptors, and intraparenchymal cells of monocytic lineage. Particular cell phenotypes (oncocytic, apocrine, neuroendocrine and clear) are critically evaluated and responses to atrophy, infarction and fine-needle aspiration biopsy procedures are highlighted together with aspects of metaplasia, regeneration, ageing and microcalcification. Areas of controversy or uncertainty which may benefit from further investigations are also discussed.
Collapse
|
17
|
Recavarren RA, Houser PM, Yang J. Potential pitfalls of needle tract effects on repeat thyroid fine-needle aspiration. Cancer Cytopathol 2012; 121:155-61. [DOI: 10.1002/cncy.21220] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/07/2012] [Accepted: 06/18/2012] [Indexed: 11/07/2022]
|
18
|
Spontaneous infarction of Warthin’s tumor: imaging findings simulating malignancy. Jpn J Radiol 2012; 30:354-7. [DOI: 10.1007/s11604-012-0056-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
|
19
|
Seethala RR, Barnes EL. Rare Malignant and Benign Salivary Gland Epithelial Tumors. Surg Pathol Clin 2011; 4:1217-1272. [PMID: 26837791 DOI: 10.1016/j.path.2011.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although at least 24 distinct histologic salivary gland carcinomas exist, many of them are rare, comprising only 1% to 2% of all salivary gland tumors. These include epithelial-myoepithelial carcinoma, (hyalinizing) clear cell carcinoma, basal cell adenocarcinoma, cystadenocarcinoma, low-grade salivary duct carcinoma (low-grade cribriform cystadenocarcinoma), oncocytic carcinoma, and adenocarcinoma not otherwise specified. Few tumors (clear cell carcinoma and basal cell adenocarcinoma) have unique molecular correlates. Benign tumors, although histologically less diverse, are far more common, with pleomorphic adenoma and Warthin tumor the most common salivary gland tumors. Many benign tumors have malignant counterparts for which histologic distinction can pose diagnostic challenge.
Collapse
Affiliation(s)
- Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, A614.X PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - E Leon Barnes
- Department of Pathology, University of Pittsburgh Medical Center, A608 PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| |
Collapse
|
20
|
Tille JC, Reychler H, Hamoir M, Schmitz S, Weynand B. Schwannoma-like pleomorphic adenoma of the parotid. Rare Tumors 2011; 3:e40. [PMID: 22355495 PMCID: PMC3282445 DOI: 10.4081/rt.2011.e40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 08/23/2011] [Indexed: 11/29/2022] Open
Abstract
Pleomorphic adenoma is the most common benign salivary gland tumour. It can occur in any salivary gland, but is most frequently found in the parotid gland. Chondroid metaplasia is a frequent finding in pleomorphic adenoma. Other forms of metaplasia have been described, but are encountered less frequently. We report a rare case of unusual pleomorphic adenoma of the parotid gland with schwannoma-like feature.
Collapse
|
21
|
Veder LL, Kerrebijn JDF, Smedts FM, den Bakker MA. Diagnostic accuracy of fine-needle aspiration cytology in Warthin tumors. Head Neck 2011; 32:1635-40. [PMID: 20848407 DOI: 10.1002/hed.21382] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Our aim was to evaluate the diagnostic accuracy of fine-needle aspiration cytology (FNAC) for Warthin tumors of the parotid gland. METHODS All cytologic diagnoses of Warthin tumor between 1990 and 2007 were correlated with available histology. In addition, our results were compared to current literature. RESULTS In 310 cases, Warthin tumor was diagnosed by FNAC. In 133 cases, (43%) both cytology and histology were available. In 127 of these 133 cases (95.5%), the diagnosis Warthin tumor was confirmed by histology. In 4 cases (3%), a benign lesion was diagnosed and 2 (1.5%) revealed a malignant lesion. On review, those cytologic diagnoses were not certain. In the literature, 11 missed malignancies (5.4%) in 202 cases were reported. CONCLUSION The diagnostic accuracy of FNAC for the diagnosis of Warthin tumor is high and the percentage of missed malignant tumors is very low. Our results imply that a cytologic diagnosis of Warthin tumor may justify conservative treatment.
Collapse
Affiliation(s)
- Laura L Veder
- Department of Otorhinolaryngology-Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | |
Collapse
|
22
|
Wade TV, Livolsi VA, Montone KT, Baloch ZW. A cytohistologic correlation of mucoepidermoid carcinoma: emphasizing the rare oncocytic variant. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:135796. [PMID: 21437180 PMCID: PMC3062076 DOI: 10.4061/2011/135796] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 01/13/2011] [Indexed: 11/20/2022]
Abstract
It is well-known that the morphological variability of mucoepidermoid carcinoma (MEC) of the salivary glands may lead to interpretative difficulties on fine-needle aspiration (FNA) diagnosis. In this study we identify morphologic features that may be useful in the FNA diagnosis of MEC. The cohort included 23 cases of MEC; cytology and histology slides were reviewed and assessed for % cystic component, extracellular mucin, mucous and intermediate cells, oncocytes, cells with foamy/clear cytoplasm, keratinized cells and lymphocytes. On FNA 12/23 (52%) cases were diagnosed as consistent with or suggestive of MEC; 6/23 (26%) as salivary gland neoplasm and 5/23 (22%) as no tumor seen. The cystic component was ≥50% in 18/23 (78%) and <50% in 5 cases. The features prevalent in FNA and histology were: mucous cells (96% and 91%), extracellular mucin (91% both), intermediate cells (100 and 83%), lymphocytes (96 and 78%) and cells with foamy/clear cytoplasm (74% both). Oncocytes were seen in 43 and 22% and keratinized cells in 48 and 13% cases. Cases with oncocytes and lymphocytes were interpreted as favor Warthin's tumor on FNA. Presence of mucous cells, cells with foamy/clear cytoplasm, intermediate cells and lymphocytes in a mucinous background are diagnostic indicators of MEC; presence of oncocytes should not refrain from diagnosing MEC in FNA specimens.
Collapse
Affiliation(s)
- Timothy V Wade
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Medical Center, 6 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | | | | | | |
Collapse
|
23
|
TAYLOR TR, COZENS NJA, ROBINSON I. Warthin's tumour: a retrospective case series. Br J Radiol 2009; 82:916-9. [DOI: 10.1259/bjr/30175196] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
24
|
Fulciniti F, Losito NS, Botti G, Manola M, Ionna F. Spontaneous infarction of pleomorphic adenoma: Report of a case simulating malignancy on fine-needle cytology sample. Diagn Cytopathol 2009; 38:430-4. [DOI: 10.1002/dc.21229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
25
|
Extensive Necrosis of Pleomorphic Adenoma in the Soft Palate: A Case Report and Review of the Literature. J Oral Maxillofac Surg 2008; 66:797-800. [DOI: 10.1016/j.joms.2007.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Accepted: 03/04/2007] [Indexed: 11/22/2022]
|
26
|
Su CC, Chou CW, Yiu CY. Neck mass with marked squamous metaplasia: a diagnostic pitfall in aspiration cytology. J Oral Pathol Med 2007; 37:56-8. [DOI: 10.1111/j.1600-0714.2007.00543.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
27
|
Alwaheeb S, Rambaldini G, Boerner S, Coiré C, Fiser J, Asa SL. Worrisome histologic alterations following fine-needle aspiration of the parathyroid. J Clin Pathol 2006; 59:1094-6. [PMID: 17021134 PMCID: PMC1861746 DOI: 10.1136/jcp.2005.029017] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Fine-needle aspiration (FNA) is a procedure that is increasingly being performed. Artefacts occurring after FNA are reported to complicate the histological analysis of the tissue, mainly in the thyroid; WHAFFT (worrisome histologic alterations following FNA of thyroid) is well documented in the literature. The case of a male patient with hypercalcaemia who was subsequently found to have a nodule in the thyroid gland is reported here. He underwent FNA, followed by a total thyroidectomy and parathyroidectomy. The abnormality in the parathyroid gland showed worrisome histological changes that were suspicious of a malignant lesion, resembling the changes seen in the thyroid gland after FNA. Parathyroid cells were identified by a review of the previous FNA. The concept of WHAFFT, which can mimic the features of malignancy in the parathyroid gland, is therefore introduced.
Collapse
Affiliation(s)
- S Alwaheeb
- Department of Laboratory Medicine and Pathobiology, University of Toronto, University Health Network and Toronto Medical Laboratories, Toronto, Canada
| | | | | | | | | | | |
Collapse
|
28
|
Alphs HH, Eisele DW, Westra WH. The role of fine needle aspiration in the evaluation of parotid masses. Curr Opin Otolaryngol Head Neck Surg 2006; 14:62-6. [PMID: 16552260 DOI: 10.1097/01.moo.0000193184.38310.0a] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Fine needle aspiration is a safe diagnostic technique that is widely employed for lesions of the head and neck. Among head and neck sites, the parotid gland stands apart for the number, diversity and peculiarity of pathologic processes to target this structure. This matchless complexity has prompted a thoughtful discussion regarding the application of the fine needle aspiration to parotid masses--a discussion that has primarily focused on the reliability of the fine needle aspiration as a diagnostic tool, and on its utility in guiding patient management. RECENT FINDINGS Recent studies have confirmed a high overall accuracy rate for fine needle aspiration evaluation of parotid masses, ranging from 90 to 95%. At the same time, these soaring accuracy rates cannot be uniformly anticipated across all diagnostic scenarios. Fine needle aspiration is notoriously unreliable in recognizing the malignant nature of the parotid carcinoma, providing its precise classification, and establishing its grade. A few malignant neoplasms are particularly prone to diagnostic error. Acinic cell carcinoma is frequently interpreted as benign or even nonneoplastic; and low-grade lymphomas are often discounted as inflammatory processes. SUMMARY Parotid gland masses are not particularly conducive to diagnostic accuracy and precision by fine needle aspiration. Accordingly, indiscriminant reliance on the fine needle aspiration findings at the expense of the clinical, radiographic, and intraoperative findings is unwarranted. Whether one uses the fine needle aspiration routinely or selectively in patients with parotid masses, the fine needle aspiration findings should contribute to, not displace, the overall diagnostic impression.
Collapse
Affiliation(s)
- H H Alphs
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21231, USA
| | | | | |
Collapse
|
29
|
Aversa S, Ondolo C, Bollito E, Fadda G, Conticello S. Preoperative cytology in the management of parotid neoplasms. Am J Otolaryngol 2006; 27:96-100. [PMID: 16500471 DOI: 10.1016/j.amjoto.2005.07.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study evaluates the diagnostic role of preoperative cytology of parotid neoplasms. The method is particularly useful in the evaluation of the parotid diseases in which the same clinical features may be treated variously. Fine-needle aspiration biopsy is a simple and well-tolerated diagnostic tool, which provides accurate information for diagnosis and follow-up of the disease. The accuracy of the method partly depends on the operator skill. MATERIALS AND METHODS From a series of 452 subjects who underwent parotidectomy, preoperative cytological evaluation was available in 310 and compared with histological diagnosis in a retrospective review. RESULTS The agreement between histotype determination using fine-needle aspiration biopsy and final histological diagnosis was 79%, specificity was 100%, sensitivity was 83%, and diagnostic accuracy was 97%. CONCLUSION These findings demonstrated that, given the low complication rate, preoperative cytology is particularly useful in diagnosing parotid disease and in planning the surgical strategy and approach.
Collapse
Affiliation(s)
- Salvatore Aversa
- Department of Otolaryngology, University of Turin, San Luigi Hospital, Orbassano, Torino, Italy
| | | | | | | | | |
Collapse
|
30
|
Maier H, Frühwald S, Sommer S, Tisch M. Kann die präoperative Feinnadelpunktion bei Parotistumoren die definitive histologische Diagnose erschweren? HNO 2006; 54:166-70. [PMID: 16091908 DOI: 10.1007/s00106-005-1303-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Fine-needle aspiration cytology (FNAC) is a minimally invasive procedure that offers high specifity and acceptable sensitivity in the preoperative diagnosis of parotid tumors. FNAC provides information that can be particularly valuable in surgical planning and patient education. In some cases, it may even help prevent unnecessary surgery. After an FNA procedure, on rare occasions, morphological changes in the tumor may be observed and can make a definitive histological examination difficult or even impossible. METHODS Histopathological changes in parotid tumors after preoperative FNAC are described on the basis of a case report and a survey of the literature. RESULTS In rare cases, puncture-induced histopathological changes, such as hyalinization of the subepithelial stroma, necrosis and squamous metaplasia, so extensive that a definitive histological diagnosis is difficult, are observed. In the present case report, fine-needle aspiration of a 3 x 2 cm tumor, which had been classified as malignant on the basis of cytological findings, resulted in complete necrosis and made a definitive histological diagnosis impossible. Similar cases have been described by other authors in recent years. DISCUSSION In rare cases, histological changes in the tumor tissue can occur after an FNA procedure, making a definitive histological examination difficult or even impossible. When a preoperative FNAC is performed, the pathologist in charge should be advised accordingly. In addition, patients should be informed about this infrequent risk before undergoing the procedure.
Collapse
Affiliation(s)
- H Maier
- Abteilung Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Bundeswehrkrankenhaus Ulm, Ulm, Germany.
| | | | | | | |
Collapse
|
31
|
Ryska A, Ludvíková M, Rydlová M, Cáp J, Zalud R. Massive squamous metaplasia of the thyroid gland – Report of three cases. Pathol Res Pract 2006; 202:99-106. [PMID: 16376021 DOI: 10.1016/j.prp.2005.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 11/01/2005] [Indexed: 10/25/2022]
Abstract
Three cases of massive squamous cell metaplasia in Hashimoto's thyroiditis are reported. The patients were two men and one woman aged 24, 52, and 55 years, respectively. In all three patients, the glandular parenchyma was replaced by hypocellular fibrous tissue with scattered chronic inflammatory infiltrate. Follicular cells were almost absent; the majority of residual epithelial cells formed squamous nests that were partly solid and partly cystic. There were three types of epithelial cells - squamous, basaloid, and follicular, with oncocytic differentiation. The squamous and basaloid cells showed strong positivity high molecular weight (HMW) cytokeratin, moderate to strong expression of galectin-3 (2/3), and nuclear expression of p63 protein (2/3). The staining pattern of p63 was identical to that of HMW, with predominant positivity at the periphery of cell nests. In one case, weak but unequivocal positivity of thyroid transcription factor-1 also was present. We believe that metaplasia was caused by Hashimoto's thyroiditis. The cases presented here are extremely rare, and only two convincing similar cases have been reported in the English literature so far. They may represent a diagnostic pitfall and should not be misdiagnosed as a malignancy, in particular as squamous cell or mucoepidermoid carcinoma.
Collapse
Affiliation(s)
- Ales Ryska
- Department of Pathology, Charles University Faculty of Medicine and Faculty Hospital, CZ-500 05 Hradec Králové, Czech Republic.
| | | | | | | | | |
Collapse
|
32
|
Zeiger MA, Dackiw APB. Follicular thyroid lesions, elements that affect both diagnosis and prognosis. J Surg Oncol 2005; 89:108-13. [PMID: 15719377 DOI: 10.1002/jso.20186] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The precise diagnosis of follicular thyroid lesions is frequently debated because of the subjective nature of capsular invasion as well as both the histological and cytological characteristics. Furthermore, several different prognostic indices have been devised to examine prognosis associated with thyroid cancer. Herein, we describe how these confounding elements can affect the ability to accurately predict prognosis for patients with follicular thyroid lesions.
Collapse
MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/pathology
- Adenoma/diagnosis
- Adenoma/pathology
- Biomarkers, Tumor/analysis
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary, Follicular/diagnosis
- Carcinoma, Papillary, Follicular/pathology
- Diagnosis, Differential
- Galectin 3/analysis
- Humans
- Keratins/analysis
- Lymphatic Metastasis
- Neoplasm Invasiveness
- Prognosis
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/pathology
Collapse
Affiliation(s)
- Martha A Zeiger
- Department of Surgery, Division of Endocrine and Oncologic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
| | | |
Collapse
|
33
|
Behzatoglu K, Bahadir B, Huq GE, Kaplan HH. Spontaneous infarction of a pleomorphic adenoma in parotid gland: Diagnostic problems and review. Diagn Cytopathol 2005; 32:367-9. [PMID: 15880698 DOI: 10.1002/dc.20268] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although infarction of parotid gland pleomorphic adenoma (PA) following fine-needle aspiration (FNA) has been well-documented, spontaneous infarction of PA has remained as an uncommon entity in the literature. To our knowledge, we report the second case of spontaneous infarction occurring in a parotid gland PA. A 44-yr-old man presented with a 2-yr history of slowly enlarging right parotid mass, which had become painful 1 mo before performing FNA biopsy. Smears revealed abundant necrotic debris, atypical squamous cells, and small cells with dark nuclei suggestive of a carcinoma. Histologic examination of the tissue fragments demonstrated degenerated clusters of cells and chondromyxoid matrix. The parotidectomy specimen had features consistent with those of an infarcted PA. Although appears to be rare, spontaneous infarction of PA should be considered in the differential diagnosis, since necrosis may mimic carcinoma and cause misinterpretation of necrosis as an indication of malignancy, in an otherwise benign salivary gland neoplasm.
Collapse
Affiliation(s)
- Kemal Behzatoglu
- Department of Pathology, SSK (Social Security Institution) Istanbul Training and Research Hospital, Istanbul, Turkey.
| | | | | | | |
Collapse
|
34
|
Favia G, Capodiferro S, Scivetti M, Lacaita MG, Filosa A, Lo Muzio L. Multiple parotid lymphoepithelial cysts in patients with HIV-infection: report of two cases. Oral Dis 2004; 10:151-4. [PMID: 15089924 DOI: 10.1046/j.1601-0825.2003.01006.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Bilateral and multiple lymphoepithelial cysts (LECs) of major salivary glands, in particular of parotid glands, are quite rare and have been reported in human immunodeficiency virus (HIV) infected patients with an incidence of about 3-6%. These lesions represent an early manifestation of HIV infection and are rarely found in patients with advanced acquired immunodeficiency syndrome. MATERIALS Two cases of parotid LECs, the first occurring in a middle-age white woman and the second in a young white boy, both in advanced phases of HIV infection, are reported. RESULTS Clinical, cytological, histological and immunohistochemical (cytokeratin AE1/AE3, CD20, CD45RA, CD8, kappa and lambda immunoglobulin light chains, S-100, MLA and Ki67) features are described. CONCLUSIONS Fine needle aspiration (FNA), a relatively non-traumatic procedure, could represent both a diagnostic and a therapeutic tool in parotid LECs. No surgical therapy is usually required for these lesions and aspiration of cystic fluid with FNA is quite resolutive, although evidence of further relapses does exist. Surgical excision may become necessary when pain, because of persistent and progressive swelling of the parotid gland, occurs.
Collapse
Affiliation(s)
- G Favia
- Department of Dental Sciences and Surgery, University of Bari, Bari, Italy
| | | | | | | | | | | |
Collapse
|
35
|
Stow N, Veivers D, Poole A. Fine-needle Aspiration Cytology in the Management of Salivary Gland Tumors: An Australian Experience. EAR, NOSE & THROAT JOURNAL 2004. [DOI: 10.1177/014556130408300214] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We conducted a retrospective study of 104 cases of salivary gland tumors that were initially assessed by fine-needle aspiration biopsy (FNAB). Based on subsequent histopathologic analysis of excised specimens, we found that preoperative FNAB was highly sensitive and specific for both benign and malignant tumors—including the most common, pleomorphic adenomas and squamous cell carcinomas, respectively. Despite its possible drawbacks, we conclude that preoperative FNAB is a useful tool in the management of salivary gland tumors.
Collapse
Affiliation(s)
- Nicholas Stow
- Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - David Veivers
- Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - Alan Poole
- Royal North Shore Hospital, St Leonards, Sydney, Australia
| |
Collapse
|
36
|
Chen YK, Lin CC, Lai S, Chen CH, Wang WC, Lin YR, Hsue SS, Lin LM. Pleomorphic adenoma with extensive necrosis: report of two cases. Oral Dis 2004; 10:54-9. [PMID: 14996296 DOI: 10.1046/j.1354-523x.2003.00966.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pleomorphic adenoma (PA) is the most common neoplasm for both the major and minor salivary glands. While PA is occasionally associated with cystic change or hemorrhage necrosis, spontaneous infarction appears to be very uncommon. We report two unusual cases of extensive necrosis of PA; one occurred in the palate with the necrotic tumor mass slipping into the oral cavity. This phenomenon, possibly associated with incision biopsy, has never been described previously. A second case, arising in the parotid with spontaneous tumor necrosis, poses some dilemma in differential diagnosis.
Collapse
Affiliation(s)
- Y K Chen
- Oral Pathology Department, School of Dentistry, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
37
|
|
38
|
Parwani AV, Ali SZ. Diagnostic accuracy and pitfalls in fine-needle aspiration interpretation of Warthin tumor. Cancer 2003; 99:166-71. [PMID: 12811857 DOI: 10.1002/cncr.11207] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite its well-defined histologic appearance, the often variegated cytomorphologic appearance of Warthin tumor (WT) on fine-needle aspiration (FNA) may lead to an erroneous cytopathologic interpretation. In this study, the authors analyzed the potential sources of diagnostic errors and overall accuracy of FNA diagnosis of WT. METHODS A retrospective search of The Johns Hopkins Hospital Surgical Pathology files (1985-2001) revealed 97 patients with WT, including 31 patients who underwent prior FNA. A comprehensive review of cytopathologic material was undertaken to calculate the overall accuracy of FNA and to identify sources of diagnostic error. RESULTS All tumors presented in the parotid gland. Four tumors (13%) were deemed inadequate for interpretation due to insufficient material. The FNA diagnosis of WT was rendered in only 20 tumors (74%). The remaining 7 tumors (26%) were misdiagnosed on FNA as consistent with or suspicious for carcinoma or some other neoplastic process. A retrospective review of the tumors, which were over-called on FNA, showed a predominance of necrotic or cellular debris (n = 6 tumors; 22%), significant epithelial metaplasia with atypia (n = 4 tumors; 15%), background inflammation suspicious for tumor diathesis (n = 3 tumors; 11%), spindle cells (n = 1 tumor; 4%), and abundant mucin with keratinized squamous cells (n = 1 tumor; 4%). CONCLUSIONS FNA is moderately accurate for diagnosing WT, with a 74% accuracy rate in the current series. Cytologic misinterpretation may occur due to a lack of characteristic cytomorphologic features of WT and overabundance of one or more of the following: squamous metaplasia/atypia, mucoid/mucinous background, spindle-shaped cells, and cystic/inflammatory debris. An adequate awareness of these potential sources of erroneous diagnoses, coupled with appropriate clinical findings, may result in a higher accuracy rate.
Collapse
Affiliation(s)
- Anil V Parwani
- Department of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA
| | | |
Collapse
|
39
|
|
40
|
Nasuti JF, Gupta PK, Baloch ZW. Clinical implications and value of immunohistochemical staining in the evaluation of lymph node infarction after fine-needle aspiration. Diagn Cytopathol 2001; 25:104-7. [PMID: 11477713 DOI: 10.1002/dc.2013] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report on a series of 3 patients who underwent fine-needle aspiration (FNA) for clinically apparent lymphadenopathy. In all 3 cases, a diagnosis of malignancy was rendered based on cytologic findings (two metastatic squamous-cell carcinomas and one melanoma). However, initial follow-up surgical pathology reported only "extensive coagulative necrosis, no viable tumor seen." Subsequent immunohistochemical stains (cytokeratins (AE1/AE3), HMB45, S100, and Melan A) demonstrated the presence of metastatic tumor in the area of infarction in each case, thus establishing the presence of metastatic tumor and correct interpretation of the initial FNA. We conclude, based on our own experience and a few previously reported cases, that total infarction of the lymph nodes following FNA can occur, and immunohistochemistry can be helpful in clinical management.
Collapse
Affiliation(s)
- J F Nasuti
- Cytopathology and Cytometry Section, Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
| | | | | |
Collapse
|
41
|
Pabuççuoglu HU, Lebe B, Sarioglu S, Lebe E. Infarction of pleomorphic adenoma: a rare complication of fine-needle aspiration obscuring definitive diagnosis. Diagn Cytopathol 2001; 24:301-3. [PMID: 11285632 DOI: 10.1002/dc.1065] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|