Multifocal nodular oncocytic hyperplasia of the parotid: case report

Multifocal nodular oncocytic hyperplasia of salivary glands is a tumor-like lesion that occurs predominantly in the parotid gland. The differential diagnosis of the clear cell variant includes many malignant salivary gland tumors. We report the case of a 66-year-old woman who was referred for a left total parotidectomy allowing the final diagnosis of clear cell multifocal nodular oncocytic hyperplasia. The differential diagnoses and histopathogenesis of this rare entity are discussed.     

Metastatic atypical meningioma to the parotid gland – A cytopathological correlation

The tumors involving the parotid gland are mainly primary, with metastatic lesions comprising only 5% of malignant salivary gland neoplasms. We are presenting a rare case of metastatic meningioma to the parotid in a 51-year-old male with a past medical history of recurrent atypical meningioma involving the frontal lobe. For the past 1.5 years, routine imaging showed parotid lesions with interval growth including a 2.0 cm dominant tender preauricular parotid mass. The chronicity and the number of lesions made malignancy unlikely. The differential diagnosis included non-specific lesions such as intraparotid lymph nodes and benign neoplasms. Fine needle aspiration of the parotid mass was performed to show loosely cohesive fragments and singly scattered neoplastic cells with mild nuclear pleomorphism and oncocytic cytoplasm. The main cytomorphologic differential diagnosis included oncocytic and myoepithelial-rich tumors. The neoplastic cells were immunoreactive to p63, calponin and SSTR2A and were negative for cytokeratins, progesterone receptor, S100, DOG-1, EMA, synaptophysin, and chromogranin. The cytology slides and the parotid gland mass resection were compared to the previous meningioma resection specimen which showed a similar morphology of the oncocytic tumor cells in some areas. The overall morphologic and immunohistochemical findings of the parotid tumor were consistent with metastatic meningioma. Extracranial metastases from intracranial tumors are extremely rare. Meningiomas arise from the dura matter, constitute 15% of primary brain tumors, and metastasize at an estimated rate of 0.1%. Despite how uncommon metastatic meningioma is, our case emphasizes the critical role of clinical history when evaluating parotid gland lesions.     

A case of oncocytic lipoadenoma of the submandibular gland and its diagnostic cytology challenges

Lipomatous tumors of the salivary gland in general are rare and oncocytic lipoadenomas are even much rarer. Most of the reported cases of oncocytic lipoadenoma were located in the parotid gland and to the best of our knowledge, only four cases reported to arise from the submandibular gland. The preoperative interpretation of the aspirates taken from these lesions can be difficult and challenging. We report a case of a 41 year old gentleman who presented with submandibular gland swelling. CT scan of the neck revealed an oval‐shape enhancing mass in the inferior aspect of the right submandibular gland measuring 19 × 12 mm. Fine needle aspiration biopsy (FNAB) showed hypocellular smears with few clusters of epithelial cells having oncocytic appearance. The cytologic findings were interpreted as “oncocytic lesion.” Submandibular gland excision was done. Histologically, a final diagnosis of oncocytic lipoadenoma was rendered. We present this rare entity to add to the few cases reported to date and to upsurge awareness during cytologic examination of oncocytic salivary gland lesions.     

Oncocytic mucoepidermoid carcinoma of the parotid gland: report of a case with DNA ploidy analysis and review of the literature

A 44-year-old female presented with a painful mass in the left parotid gland. Histologic examination revealed the characteristic picture of oncocytic mucoepidermoid carcinoma (OMEC) composed mainly of sheets of oncocytic cells with uniform nuclei and eosinophilic cytoplasm, focally smaller epidermoid cells surrounding poorly formed glandular spaces, and a few cystic structures lined by well-differentiated mucous cells with intracytoplasmic mucin. Immunohistochemical staining with antimitochondrial antibody showed granular cytoplasmic positivity in oncocytic cells. The resulting histogram for DNA ploidy analysis was of diploid type. OMEC of the parotid gland is a recently described rare neoplasm. Only six cases have been previously reported in the literature. For an accurate approach in the management of patients, OMEC should be considered in the differential diagnosis of oncocytic lesions of the parotid gland, most of which are benign.     

An ultrastructural study of oncocytoma and oncocytic carcinoma of the parotid gland

One case of oncocytoma and another of oncocytic carcinoma of the parotid gland are reported with ultrastructural studies. The incidence of oncocytoma varies from 0.1% to 1.4% of all parotid gland tumors, while oncocytic carcinoma is extremely rate. The oncocytoma was composed of polyhedral cells with fine eosinophilic granular cytoplasm and a rounded nucleus. The tumor cell clusters were surrounded by basement membrane. The tumor cells of the oncocytic carcinoma were also characterized by eosinophilic cytoplasm, but cellular atypia and mitotic figures were found. Electron microscopically, the cytoplasm of the oncocytoma was packed with abundant mitochondria. They were oval or elongated in shape with stacked cristae. Although the tumor cells of the oncocytic carcinoma also contained many mitochondria, their number was less than that of the benign case, and stacked cristae were very few. Basement membrane was not seen. The ultrastructural characteristics of oncocytoma and oncocytic carcinoma of the parotid gland are discussed with reference to previous reports.     

Oncocytic lipoadenoma of the parotid gland: a report of a new case and review of the literature

Oncocytic lipoadenoma is a rare salivary gland tumour composed of adipose tissue and oncocytic epithelial cells in varied proportions. This tumour is still not included in the current WHO classification of salivary gland neoplasms. We herein report a further case of oncocytic lipoadenoma originating in the parotid gland of a 55-year-old woman. The tumour presented as a slowly growing asymptomatic left-sided parotid gland mass. The resected tumour measured 2.7 cm in maximum diameter and was composed of oncocytoma-like epithelial component admixed with mature adipocytes that made up 10% of the whole mass. Foci of sebaceous differentiation were seen. This rare variant of lipomatous salivary gland tumours is in need of more recognition and should be distinguished from other fat-containing salivary gland lesions, particularly lipomatous pleomorphic adenoma and myoepithelioma.     

Evaluation of fine needle aspiration cytology of salivary glands: an analysis of 141 cases

141 salivary gland lesions that were subjected to fine needle aspiration (FNA) cytology at the University Hospital, Kuala Lumpur, from January 1993 to October 2000 were reviewed with a view to assess the sensitivity and utility of cytological diagnosis in diseases of salivary glands. The highest number of cases was seen in the sixth decade of life. There was no gender preponderance in salivary gland neoplasms except in Warthin's tumours that occurred predominantly in males. The parotid gland was the most frequent salivary gland needled. Seven cases (5%) presented with bilateral salivary gland enlargement. Cytological study yielded a neoplastic diagnosis in 74.5% cases. Of the neoplastic lesions, 71.4% could be definitely designated as benign and 25.7% as clearly malignant. Pleomorphic adenoma and acinic cell carcinoma were the most common benign and malignant neoplasms diagnosed respectively. 53 cases had histological correlation; of these, 49 (92.5%) were neoplastic. The overall diagnostic accuracy of FNA cytological diagnosis in salivary gland lesions was found to be 73.6%.     

Tumor-to-tumor metastasis of renal cell carcinoma into oncocytic carcinoma of the thyroid. Report of a case and review of the literature

A case of a multifocal oncocytic carcinoma of the thyroid with intratumoral metastases of renal cell carcinoma in a 52-year-old male is reported. Thirteen months before the presentation of the thyroid lesion, the patient underwent nephrectomy for a renal cell carcinoma. The thyroid tumor clinically presented as a palpable nodule. Preoperative fine-needle aspiration cytology showed two cell types: oncocytes and multivacuolated clear cells. The cytologic features were interpreted as a coincidence of an oncocytic tumor of the thyroid and metastasis of a clear cell renal carcinoma. The diagnosis was confirmed by histologic and immunohistochemical examinations. Interestingly, except for metastases within multiple foci of the oncocytic carcinoma, there were no metastatic deposits in nontumoral thyroid. Although the occurrence of tumor-to-tumor metastasis in thyroid gland is exceptionally rare, with only 12 such cases reported to date, one should be aware of this phenomenon to avoid an incorrect diagnosis. To the best of our knowledge, this is the first report of a metastasis into tumor of the thyroid gland, with oncocytic carcinoma being the recipient.     

Oncocytic lipoadenoma of the parotid gland: Cytological findings and differential diagnosis on fine‐needle aspiration

Oncocytic lipoadenoma is a rare benign neoplastic lesion of salivary gland. To the best of our knowledge, the detailed cytomorphological findings were described only in two cases. We are reporting a 56‐year‐old woman who presented with 1‐year history of right parotid gland mass. Cytologic examination revealed tight clusters of bland looking oncocytic ductal cells with few aggregates of mature adipose tissue in a lipoid background and a benign oncocytic tumor of parotid gland was rendered. Histologically, a tumor with islands of oncocytic epithelial cells admixed with abundant mature adipose tissue was identified. Oncocytic lipoadenoma despite its rarity should be considered in the differential diagnosis of salivary gland fine‐needle aspirations containing oncocytes especially those which are accompanied by mature adipose tissue and lipoid background. Diagn. Cytopathol. 2015;43:72–74. © 2014 Wiley Periodicals, Inc.     

Needle aspiration cytology of an oncocytic carcinoma of the parotid gland

A needle aspirate biopsy of a parotid neoplasm yielded uniform benign oncocytic cells consistent with oncocytoma. The subsequent surgical specimen demonstrated an oncocytic carcinoma with vascular and perineural invasion. These findings are analogous to those of oxyphilic tumors of the thyroid gland where cytologic features often do not allow for distinction between benign and malignant lesions.     

Metastatic renal cell carcinoma,clear cell type,of the parotid gland

Renal cell carcinoma (RCC), clear cell type, is a commonly encountered metastatic tumor that can present at unusual anatomic sites many years after the primary tumor resection. Noncutaneous metastasis to the parotid gland is unusual; however, a number of cases of parotid RCC metastasis have been reported. Fine‐needle aspiration biopsy (FNAB) is regularly utilized during the evaluation of salivary gland lesions, where it has a high sensitivity, specificity, and accuracy; however, the identification and definitive diagnosis of primary and metastatic clear cell neoplasms is a potential diagnostic pitfall for salivary gland FNAB. Here, we describe a case of RCC, clear cell type, metastatic to the parotid gland that was diagnosed entirely from FNAB cell block material, which is the first such reported case to our knowledge. We review the literature for cases of parotid RCC metastasis and focus on the utility of FNAB for synchronous versus metachronous presentations. Finally, we evaluate the differential diagnosis of clear cell parotid lesions, including ancillary histologic studies, and propose an algorithmic approach to clear cell neoplasms of the salivary gland. Diagn. Cytopathol. 2014;42:974–983. © 2014 Wiley Periodicals, Inc.     

HIV infection-associated lymphoepithelial lesions of the parotid gland: aspiration biopsy cytology, histology, and pathogenesis

Two homosexual men with parotid swellings were shown to be human immunodeficiency virus (HIV)-positive. They initially presented with a painless solitary parotid mass accompanied by diffuse cervical lymphadenopathy. In case 1, the patient further developed bilateral multiple cystic lesions. Aspirate preparations from the cystic lesions contained numerous anucleate squames, and superficial and intermediate squamous cells intermingled with various follicular center cells and lymphocytes. Immunoblasts and active phagocytosis of nuclear debris were also noted. Histologically, the parotid cystic lesions showed squamous epithelium-lined clefts surrounded by abundant hyperplastic lymphoid tissue with prominent germinal centers. The cystic lesions did not involve submandibular and sublingual glands. The combination of bilateral multiple lymphoepithelial lesions of the parotid glands and diffuse cervical lymphadenopathy represents a new condition in patients who are likely to be HIV-positive. At the early stage of the disease, when the lesion is confined to a unilateral parotid gland, the cytologic findings of the parotid mass, in combination with a computed tomographic appearance of multiple cystic lesions, are distinctly different from findings in other neck and facial lesions. The patient should be tested for antibodies to the HIV virus to confirm this diagnosis, so that the appropriate precautions and treatment can be initiated.     

A case of sarcoidosis associated with Sj?gren's syndrome]

A 49-year-old woman, who has had a past history of Raynaud's phenomenon since 1981, dry mouth since 1987 and dry eyes since 1990, was admitted to our hospital complaining of general fatigue, bilateral gonalgia, and shortness of breath in April 1991. Physical examinations revealed bilateral parotid gland enlargement and bilateral uveitis. Her family history included mixed connective tissue disease in her eldest daughter. Laboratory findings indicated an elevated erythrocyte sedimentation rate, hypergammaglobulinemia, and elevation of serum lysozyme and angiotensin converting enzyme levels. Antinuclear antibodies, anti-SSA antibodies, anti-SSB antibodies were positive, while tuberculin test was negative. Chest X-rays showed bilateral hilar lymphadenopathy and small nodular shadows in both lung fields. Increases in lymphocytes and the CD4/CD8 ratio of T cells were noted in alveolar lavage fluid. Renal biopsy revealed non-caseous granulomas. Other remarkable findings included positive Schirmer's test, apple tree lesions by sialography and chronic sialoadenitis by biopsy of the labial minor salivary gland. On the basis of all these findings, we diagnosed her as suffering from sarcoidosis with Sj?gren's syndrome. After oral administration of prednisolone, her shortness of breath, hilar lymphadenopathy and small nodular shadows in the lung field disappeared, but the patient was transferred to the department of urology due to the onset of hydronephrosis. This case is noteworthy because sarcoidosis associated with Sj?gren's syndrome has been reported in only 11 cases in the literature.     

CT features and pathologic characteristics of lymphoepithelial carcinoma of salivary glands

Objective: To investigate and analyze the typical CT findings of salivary gland lymphoepithelial carcinoma. Methods: CT findings in 8 patients with lymphoepithelial carcinoma (LEC) in salivary gland were studied retrospectively. Surgical resection was performed in all cases. Results: 8 cases were subdivided to primary tumor and secondary tumor. In primary tumor group, 5 were localized in the parotid gland, 2 were found in the submandibular glands; 6 lesions had with homogeneous density, 1 was associated with cystic degeneration and 1 with calcification; the margins of lesions in 5 cases were poorly defined, while well-defined in 2. On enhanced CT: obvious enhancement was achieved in all of the 7 solitary lesions, among which 4 were homogenously enhanced while the other 3 had heterogeneous enhancement. In the 2 cases of nodules in deep lobe, retromandibular vein was affected; 7 patients had positive Epstein-Barr virus (EBV) test, with Ki-67 measurements ranged from 40% to 80%. 1 patient had LEC secondary to Benign Lymphoepithelial Lesion (BLEL), with involvement of bilateral parotid glands; the lesion was manifested as multiple differently-sized nodules, with partial cystic change, all of the nodules had clear margins, and obvious ring-shape enhancement was seen in the nodules with cystic change; the patient with secondary LEC had negative EBV test and a Ki-67 value of 20%. Conclusion: In most cases, LEC was primary and occurred in the parotid glands. The probable diagnosis could be made based upon Dual-phase contrast-enhanced CT scan findings combined with positive expression of EBV.     

Epithelial myoepitheial carcinoma of minor salivary gland--low grade malignant tumor presenting with nodal metastasis

Epithelial myoepithelial carcinoma (EMC) is a rare low grade malignant salivary gland neoplasm that most commonly occurs in the parotid gland but can also arise in minor salivary glands. We report a case of primary epithelial myoepithelial carcinoma of minor salivary gland in a 25 year old women who presented with swelling left cheek of one year duration and bilateral submandibular lymphadenopathy. A mass causing erosion of mandible, thyroid cartilage and masseter muscle was identified on CT scan. This was excised and histological examination revealed a mixture of ductal structures consisting of inner dark cells and outer clear cells seen in solid sheets. Immunohistochemical analysis showed the clear cells to be weakly positive for S100 and smooth muscle actin (SMA) and ductal cells to be positive for cytokeratin (CK) and epithelial membrane antigen (EMA). The characteristic morphological and immunohistochemical features aided in the diagnosis of epithelial myoepithelial carcinoma.     

Oncocytic variant of mucoepidermoid carcinoma of submandibular gland: an unusual clinical and morphological entity

In this case report we describe a rare tumor--Oncocytic variant of Mucoepidermoid carcinoma of the submandibular salivary gland with a review of the literature. Oncocytic metaplasia in salivary glands is a benign change that is associated with increasing age and also seen in a few salivary gland neoplasms', which include oncocytoma, Warthin's tumor, and the rare, oncocytic carcinoma. Oncocytic differentiation in mucoepidermoid carcinoma (MEC) is uncommon. Only twelve well-documented cases of oncocytic MEC have been reported previously all of which occurred in the parotid gland. To the best of our knowledge this is the first case of oncocytic mucoepidermoid carcinoma involving the submandibular salivary gland. The recognition of this entity is important, since most of the other primary oncocytic lesions of the salivary gland are benign.     

Fine-needle aspiration cytology of lymphangioma of the parotid gland in an adult

Lymphangioma or cystic hygroma is an uncommon benign congenital tumor of lymphatics that is seen in children and, rarely, adults. Lymphangioma primarily involving the parotid gland is an extremely uncommon occurrence in adults. We report on the cytologic findings of a parotid lymphangioma in a 34-yr-old man which showed 13 cc of yellow fluid with red blood cells, lymphocytes, and rare fragments of benign-appearing salivary gland epithelium. The differential diagnosis of cystic parotid gland lesions in adults may include Warthin's tumor, lymphoma, benign lymphoepithelial lesions, branchial cleft cysts, chronic sialadenitis, cystic low-grade mucoepidermoid carcinoma, and cystic pleomorphic adenoma. In this case, the fine-needle aspiration findings along with the magnetic resonance imaging (MRI) findings of a multiloculated cystic mass in the parotid gland allowed the diagnosis of lymphangioma.     

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. © 1995 Wiley-Liss, Inc.