Fine-needle aspiration biopsy of the salivary gland: Problem cases

Among 582 fine-needle aspiration (FNA) biopsies of major and minor salivary glands performed between 1974 and 1990, lack of cytological histologic correlation was noted in 21 cases. Of these, the cause in 10 FNAs was inadequate cytological sampling of the lesion. [One case of malignant hemangiopericytoma was tentatively diagnosed as a monomorphic adenoma on FNA, a polymorphic T-cell lymphoma was diagnosed as granulomatous inflammation on aspiration biopsy, a benign lymphoepithelial lesion was diagnosed as a reactive lymph node, a branchial cleft cyst was called benign mixed tumor (BMT), one case of chronic sialoadenitis was called BMT by FNA, two cases of benign lymphoepithelial lesion (BLEL) were diagnosed as cystic Warthin's tumor, two low-grade mucoepidermoid carcinomas were called BMT, and a BMT was cytologically diagnosed as a Warthin's tumor with squamous metaplasia versus low-grade mucoepidermoid carcinoma. One case of low-grade mucoepidermoid carcinoma was diagnosed only as a “cyst.”] Review of these cases identifies constant features that permit differentiation between Warthin's tumor and BLEL, and among BMT, mucoepidermoid carcinoma, and chronic sialoadenitis. Despite a few problem cases, FNA of the salivary gland is accurate in the preoperative diagnosis and classification of salivary gland neoplasms.     

Fine-needle aspiration cytology of terminal duct carcinoma of minor salivary gland

The cytologic features of terminal duct carcinoma of the palate, as observed in a fine-needle aspiration specimen, are described and contrasted with the cytologic features reported for benign mixed tumor, basal-cell adenoma, and adenoid cystic carcinoma. Terminal duct carcinoma, at times, may be difficult, if not impossible, to distinguish from adenoid cystic carcinoma in fine-needle aspiration specimens. In most instances, this distinction may not be important.     

Fine-needle aspiration cytology of malignant hemangiopericytoma of the salivary gland: A case report

A 79-yr-old woman presented with a 5-yr history of swelling of the left cheek. The fine-needle aspiration (FNA) smear showed a spindle-cell neoplasm with capillaries and benign endothelial cells. The spindle cells possessed pleomorphic, hyperchromatic elongated nuclei and a moderate amount of ill-defined cytoplasm. They also showed papillary arcades surrounded and encased by relatively small ovoid to short spindle cells. Subsequent surgical excision confirmed the presence of malignant hemangiopericytoma (HP). Immunohistochemical studies on the histologic section using vimentin were strongly positive, consistent with HP. To the best of our knowledge, this is the second published report of FNA cellular features of malignant HP of the salivary gland. Besides delineating the FNA cellular features of HP of the salivary gland, the present case illustrates the value of using immunohistochemical approaches. Diagn. Cytopathol. 1999;21:398-401.     

Fine-needle aspiration cytology of salivary glands: diagnostic pitfalls--revisited

Fine needle aspiration cytology (FNAC) of salivary gland lesions is a safe, effective diagnostic technique. Several amply illustrated reviews are available in the English literature. The reported diagnostic accuracy varies between 86% to 98%. The sensitivity ranges from 62% to 97.6% and specificity is higher from 94.3% to 100%. In this present study, we have analyzed 172 cases of salivary gland aspirates and the histopathological diagnosis was available in 45 cases. There was discordance in cytological and histopathological diagnosis in nine cases. Five cases had discrepancies in benign versus malignant diagnosis with four cases being false negative. The errors in these FNA diagnoses were due to sampling error, observational error and interpretational error. Therefore, this study illustrates high diagnostic accuracy of FNAC in salivary gland lesions and shows that FNAC offers valuable information that allows the planning of subsequent patient management.     

Fine-needle aspiration cytology of seminoma: A review of 16 cases

We report the cytomorphologic features of 16 fine-needle aspiration (FNA) biopsies of seminoma obtained from 16 male patients. the aspirates included two primary gonadal tumors (one occurring in a cryptorchid testis), two primary mediastinal tumors, and 12 metastases (two with unknown primaries). Analysis of the aspirates revealed a primarily dispersed cell population of large cells with scant to moderately abundant cytoplasm. the nuclei were round to slightly irregular, had finely granular chromatin, and had either one central prominent nucleolus or two to three smaller nucleoli. Variable numbers of lymphocytes and plasma cells were intermingled with the tumor cells. Only a few cases had epithelioid histiocytes or the characteristic “tigroid” background. the cytologic features of the metastases were distinctive and were considered diagnostic for therapeutic management. in six cases, an initial diagnosis of seminoma by FNA biopsy identified the neoplasm as germ cell in origin rather than other neoplasms in the differential diagnosis, thereby expediting therapeutic management. © 1995 Willey- Liss, Inc.     

Fine-needle aspiration biopsy of salivary gland mycoses

This report details the fine-needle aspiration biopsy (FNAB) cytomorphologic features of two cases of salivary gland mycosis. Both patients had acquired immunodeficiency syndrome (AIDS) and presented with parotid gland masses. The first patient had Histoplasmosis with secondary infection by Candida. Cytopathologically, the FNAB smears showed classic features of a deep-seated mycosis characterized by necrosis and scattered fungal forms. The second patient had a colonizing sialadenitis caused by either Asperigillus or Fusarium. Cytopathologically, the findings were similar to those seen in aspergillomas of the lung orparanasal sinuses with numerous hyphal forms and an absence of an inflammatory response. Because mycotic disease can induce a wide spectrum of pathogenic change, other benign or malignant, solid or cystic lesions enter into the differential diagnosis. Diagn Cytopathol 1994; 11:286–290. © 1994 Wiley-Liss, Inc.     

Fine-needle aspiration cytology of lipoblastoma: a report of two cases

Lipoblastoma is an uncommon lipomatous tumor that typically occurs in infants and children. It may present as a single subcutaneous nodule or with multiple lesions (lipoblastomatosis). We describe fine-needle aspiration (FNA) cytologic features of two cases that presented as a subcutaneous lump in the scapular area and as a deeply located mass in the left arm. Smears showed fragments of adipose tissue that consisted of numerous vacuolated adipocytes with few stroma. Nuclei were small and located centrically, without indentations. Myxoid stromal material was a remarkable finding in one case. Both cases showed small delicate vessels, mainly in relation with the myxoid material. No necrosis, atypia, or mitotic figures were present. Cytologic features were characteristic enough to permit a specific diagnosis (adipose tumor suggestive of lipoblastoma). The differential diagnosis should consider lipoma with regressive changes, well-differentiated and mixoid liposarcoma. In addition to cytologic features, the patient's age is very useful for differentiation.     

Fine-needle aspiration cytology of hemangiopericytoma: report of two cases

The fine-needle aspiration biopsy (FNAB) findings in two cases of hemangiopericytoma (HP), arising in the parotid gland and on the inner chest wall, respectively, are reported. Smear preparations in each case showed cytologic features of an undifferentiated spindle-cell neoplasm, whereas a core needle biopsy specimen of the chest wall mass showed a spindle-cell tumor with a "staghorn-like" arrangement of endothelium-lined vascular channels. Immunostains performed on this core biopsy, and on the surgical resection specimens in both cases, showed positive staining of tumor cells for vimentin and CD34, with negative staining for a variety of smooth muscle, epithelial, neural, and neuroendocrine markers. Electron microscopy performed in one case further supported the diagnosis of HP. With adequate sampling and appropriate use of ancillary studies, a diagnosis of HP can be reliably suggested on the basis of FNAB and core biopsy of a soft-tissue mass.     

Fine-needle aspiration cytology of Kikuchi's lymphadenitis: a report of ten cases

The purpose of this study was to evaluate the cytologic features of Kikuchi's lymphadenitis (KL). Smears from 10 patients with histologically proven KL were reviewed. In all cases, fine-needle aspiration (FNA) was performed prior to biopsy. To assess the validity of morphologic recognition, a blinded study, including smears from non-Hodgkin's lymphomas, nonspecific, and mycobacterial lymphadenitis was performed. At least 5 cases showed characteristic cytologic findings that permitted their specific recognition. A polymorphous lymphoid population with abundant karyorrhectic debris and histiocytes, many of which showed a small size and eccentrically placed, crescent nuclei, were characteristic features of KL. The remaining 5 cases failed to show typical findings and were indistinguishable from other nonspecific, reactive lymphadenopathies. When typical cytologic findings are present in an adequate clinical context (cervical nodes in young patients), a precise diagnosis is possible, avoiding unnecessary biopsies.     

Fine-needle aspiration cytology of the canine apocrine sweat gland carcinoma

Tumors of apocrine sweat glands are uncommon in comparison to tumors of sebaceous glands in dogs. Animals older than 8?years of age are most likely to develop these tumors. The authors report a case of apocrine sweat gland carcinoma in a 2-year-old crossbred dog that was diagnosed by fine-needle aspiration cytology. The technique was shown to be helpful for the correct diagnosis and treatment approach. However, despite being time consuming, the histopathological study remains the method of choice for accurate classification of the disease.     

Fine-needle aspiration cytology of juvenile hemangioma of the parotid gland: a case report

A 4-mo-old child presented with a 20-day history of swelling of the left cheek. Fine-needle aspiration (FNA) biopsy revealed a spindle-cell neoplasm with a bloody background. Subsequent surgical excision confirmed the presence of a juvenile hemangioma (juvenile hemangioendothelioma). The FNA biopsy and surgical pathology findings are presented along with a discussion of the differential diagnosis of this relatively rare neoplasm.     

Fine-needle aspiration cytology of lymphoproliferative lesions involving the major salivary glands

Fine-needle aspiration biopsy (FNA) is an accurate and cost-effective procedure for evaluating salivary gland lesions. Lymphoproliferative lesions may manifest as salivary gland enlargement. We report our experience with 43 cases of reactive and neoplastic lymphoproliferative lesions of the salivary glands evaluated by FNA, including 23 cases of reactive lymphoid hyperplasia and 20 neoplastic lymphoproliferative processes. The latter included 2 multiple myelomas and 18 non-Hodgkin lymphomas (small lymphocytic lymphoma/chronic lymphocytic leukemia, 1; small cleaved cell lymphoma, 1; lympho-plasmacytoid lymphoma, 1; mucosa-associated lymphoid tissue lymphoma, 2; mixed cell lymphoma, 4; lymphoblastic lymphoma, 1; and large cell lymphoma, 8). There were no false-negative diagnoses. Aspiration smears from 3 patients with reactive lymphoid hyperplasia and 4 patients with malignant lymphoma initially were interpreted as atypical lymphoid proliferations or as suggestive of malignant lymphoma. Thus, FNA had a sensitivity of 100% and a specificity of 87%. The majority of patients were treated medically without surgical intervention. Among the patients who underwent surgical resection of the salivary gland, 7 had an equivocal cytologic diagnosis and 2 had a benign cytologic diagnosis, but their parotid swelling failed to regress despite medical treatment. In most instances, FNA provides useful information for subsequent disease management and obviates surgical intervention.     

Fine-needle aspiration cytology of mammary fibromatosis: Report of two cases

The purpose of this study is to evaluate cytologically two cases of mammary fibromatosis (MF). Prior to FNAC, clinical and mammographic suspicion of carcinoma and fibroadenoma were present. In both cases cytology disclosed the presence of numerous spindle cells admixed with epithelial cells. In the first case, carcinoma was excluded and the diagnosis of “spindle-cell proliferative lesion” was established. The second case was erroneously diagnosed as “cellular fibroadenoma” due to the presence of monolayered ductal epithelial groups and stromal tissue. In both cases local excision of the lesion was recommended. Although in a strict sense fibromatosis is a pure stromal lesion, the frequent presence of epithelial groups in the smears should raise a differential diagnosis with other more frequent mixed (epithelial and stromal) lesions such as fibroadenoma, cystosarcoma phyllodes, and metaplastic carcinoma. Due to the fact that clinically and mamographically MF is frequently confused with malignancy, preoperative recognition is essential since in many cases it would avoid unnecessary radical surgery. In this sense cytology offers very important preoperative information. Diagn. Cytopathol. 1997;17:363–368. © 1997 Wiley-Liss, Inc.     

Diagnosis of salivary gland tumors by fine-needle aspiration cytology: a review of clinical utility and pitfalls

Fine-needle aspiration cytology has become a frequently used technique for the diagnosis of neoplasms of the head and neck. While the method has a high sensitivity and specificity for the diagnosis of salivary gland lesions, important pitfalls for the cytologic diagnosis of these lesions exist. This paper discusses the diagnostic pitfalls and investigates strategies for the evaluation of salivary gland masses.     

Fine-needle aspiration biopsy of low-grade cribriform cystadenocarcinoma of the salivary gland

Low-grade cribriform cystadenocarcinoma (LGCCC) is a rare tumor, defined in the 2005 WHO classification as a primary salivary duct tumor. Previously, the neoplasm had been recognized as a variant of salivary duct carcinomas. A 56-year-old Japanese woman noticed a mass in the left subaural region. On radiological examinations, a multicystic tumor was seen in the left parotid gland. Fine-needle aspiration biopsy was performed. The smears revealed several characteristic cytologic features. The tumor cells were arranged in irregular overlapping and showed inconspicuous nuclear atypia with variable-sized and irregularly shaped cytoplasmic vacuoles. Based on these findings, a cystic tumor with uncertain malignancy was diagnosed. A parotidectomy was performed, because the tumor was slowly growing and contained solid components on the radiological images. Based on the histologic findings, along with immunohistochemistry, LGCCC was diagnosed based on resemblance to breast low-grade ductal carcinoma in situ and intraductal proliferation of tumor cells. This is the first report of the cytomorphological findings of LGCCC.     

Fine-needle aspiration cytology of pancreatoblastoma

Pancreatoblastoma is a rare pancreatic neoplasm seen most commonly in the pediatric age group. We report on the aspiration cytology and immunohistochemical findings of a pancreatoblastoma in a 16-yr-old male.     

Fine-needle aspiration cytology of an oncocytic carcinoma of the submandibular gland

An oncocytic carcinoma of the submandibular gland diagnosed by fine-needle aspiration is reported. Cytologically, the tumor cells occurred singly, in three-dimensional clusters and in multilayered sheets. The cells had round-to-oval, centrally or eccentrically located nuclei with fine chromatin and prominent nucleoli. Many cells contained abundant granular cytoplasm and well-defined cell borders; however, several stripped nuclei with prominent nucleoli were also noted in the background. Follow-up histologic examination showed tumor cells arising from right submandibular gland and metastasizing to six of 14 cervical lymph nodes. Ultrastructural study demonstrated tumor cells packed with mitochondria in the cytoplasm. The patient was alive with no evidence of disease 6 months after the surgery. Diagn. Cytopathol. 1998;19:186–189. © 1998 Wiley-Liss, Inc.