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1
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Taweevisit M, Sutthiruangwong P, Thorner PS. Acantholytic squamous cell carcinoma mimicking epithelioid angiosarcoma: A diagnostic challenge by cytology. Diagn Cytopathol 2024; 52:E76-E79. [PMID: 38069674 DOI: 10.1002/dc.25265] [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: 07/27/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 02/07/2024]
Abstract
Squamous cell carcinoma (SCC) is the most common malignancy of the head and neck region. Most cases present little diagnostic difficulty on fine needle aspiration (FNA), but unusual variants can be problematic. The authors report a case of the acantholytic SCC of the oral cavity in a 36-year-old male. The FNA showed hypercellularity, with malignant cells arranged in isolation, loosely cohesive groups and a linear configuration. Such cells were round to elongated, with vesicular nuclei and prominent nucleoli. Cells possessed occasional intracytoplasmic vacuoles, misinterpreted on FNA to be vasoformative features as seen in malignant endothelial cells. The cytologic diagnosis was "positive for malignancy, suggestive of angiosarcoma". A total excision was performed and by histology, the tumor was diagnosed as acantholytic SCC. The malignant cells were positive by immunostaining for AE1/AE3, p40, p63 and vimentin, but negative for CD31, CD34 and ERG. The intracytoplasmic vacuoles were PAS- and mucin-negative and negative for the above antibodies. Testing for HPV (molecular and p16 immunostaining) was negative. This case highlights the diagnostic challenges on cytology when malignant acantholytic squamous cells show intracytoplasmic vacuoles, and stresses how immunohistochemistry is important for distinguishing acantholytic SCC from other mimics.
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Affiliation(s)
- Mana Taweevisit
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Paul Scott Thorner
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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2
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Tofanelli M, Rigo S, Polesel J, Zanconati F, Bonazza D, Vito Marcuzzo A, Gardenal N, Boscolo-Rizzo P, Tirelli G. Accuracy of fine-needle aspiration and frozen section for the detection of squamous metastasis in cystic masses of the lateral neck. Br J Oral Maxillofac Surg 2022; 60:1261-1265. [DOI: 10.1016/j.bjoms.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/07/2022] [Accepted: 07/22/2022] [Indexed: 10/16/2022]
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3
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AlGhamdi GZ, Alzahrani AK, Saati H, Algarni HM, Alshehri KA, Baroom M, Awad BI, Algarni M, Al-Hakami HA. Correlation Between Fine Needle Aspiration Cytology (FNAC) and Permanent Histopathology Results in Salivary Gland Masses. Cureus 2021; 13:e13976. [PMID: 33884234 PMCID: PMC8054946 DOI: 10.7759/cureus.13976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective Fine-needle aspiration cytology (FNAC) has been widely accepted as a diagnostic safe method for preoperative assessment of salivary gland lesions. This diagnostic tool is inexpensive, easy to perform, relatively painless and it provides useful information to differentiate between benign and malignant salivary gland tumors that helps in the management and surgical planning. This study was undertaken to compare FNAC results with permanent histopathological findings of salivary gland tumors in order to assess its diagnostic accuracy. Materials and methods A total of 37 archived salivary gland FNAC specimens collected between January 2001 and January 2018 were correlated with proven histopathology findings. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated. False negative and false positive cases were determined. Results There were 20 female and 17 male patients. Parotid tumors count for 62.2% and submandibular tumors 37.8%. All cases of malignancy on FNAC were proven to be malignant on the final pathology findings. All cases that were suspicious for malignancy on FNAC were proven to be malignant as well. In addition, three false negative cases were seen and no false positive cases among all FNAC cases. In our series, the overall sensitivity and specificity were 90.3% and 100%, respectively. The positive and negative predictive values were 100% and 57.1%, respectively. The diagnostic accuracy was 91.4%. Conclusion This study demonstrated that FNA cytology of the salivary gland is a useful technique for diagnosis of salivary gland lesions. Insufficient cellularity was the most important factor that resulted in incorrect cytological interpretation.
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Affiliation(s)
- Ghassan Z AlGhamdi
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ali K Alzahrani
- Otolaryngology - Head and Neck Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Hisham Saati
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Hussam M Algarni
- Orthopaedics, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Khalid A Alshehri
- Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Muhannad Baroom
- Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Baraa I Awad
- College of Medicine, Department of Otolaryngology - Head & Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
| | - Mohammed Algarni
- Otolaryngology - Head and Neck Surgery, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Hadi Afandi Al-Hakami
- College of Medicine, Department of Otolaryngology - Head & Neck Surgery, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Jeddah, SAU
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4
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Teshima M, Tokita K, Ryo E, Matsumoto F, Kondo M, Ikegami Y, Shinomiya H, Otsuki N, Hiraoka N, Nibu KI, Yoshimoto S, Mori T. Clinical impact of a cytological screening system using cyclin D1 immunostaining and genomic analysis for the diagnosis of thyroid nodules. BMC Cancer 2019; 19:245. [PMID: 30885146 PMCID: PMC6423761 DOI: 10.1186/s12885-019-5452-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background Fine-needle aspiration (FNA) is the most reliable method for diagnosing thyroid nodules; however, some features such as atypia of undetermined significance or follicular lesion of undetermined significance can confound efforts to identify malignancies. Similar to BRAF, cyclin D1 may be a strong marker of cell proliferation. Methods One hundred two patients with thyroidal nodule were enrolled in this prospective study. Expression of cyclin D1 in thyroid nodules was determined by immunohistochemistry using both surgical specimens and their cytological specimens. The identification of the optimal cut off points for the diagnosis of malignancy were evaluated using the receiver operating characteristic (ROC) curves and the assessment of the area under the ROC curve (AUC). The specificity, sensitivity, positive predictive value (PPV) of markers were evaluated from crosstabs based on cut off points and significance were calculated. We also analyzed genetic variants by target NGS for thyroid nodule samples. Results The positive predictive value (PPV) and median stain ratio (MSR) of cyclin D1 nuclear staining was determined in papillary thyroid carcinoma (PPV = 91.5%, MSR = 48.5%), follicular adenoma (PPV = 66.7%, MSR = 13.1%), and adenomatous goiter and inflammation controls (MSR = 3.4%). In FNA samples, a threshold of 46% of immunolabelled cells allows to discriminate malignant lesions from benign ones (P < 0.0001), with 81% sensitivity and 100% specificity. A 46% cutoff value for positive cyclin D1 immunostaining in thyroid cells demonstrated 81% sensitivity and 100% specificity. In surgical specimens, ROC curve analysis showed a 5.8% cyclin D1 immunostaining score predicted thyroid neoplasms at 94.4% sensitivity and 92.3% specificity (P = 0.003), while a 15.7% score predicted malignancy at 86.4% sensitivity and 80.5% specificity (P < 0.0001). Finally, three tested clinico-pathological variables (extra thyroidal extension, intraglandular metastasis, and lymph node metastasis) were significant predictors of cyclin D1 immunostaining (P < 0.001). Conclusion Our cytological cyclin D1 screening system provides a simple, accurate, and convenient diagnostic method in precision medicine enabling ready determination of personalized treatment strategies for patients by next generation sequencing using cytological sample. Electronic supplementary material The online version of this article (10.1186/s12885-019-5452-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Masanori Teshima
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan.,Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan.,Department of Otolaryngology - Head and Neck Surgery, Kobe University, School of Medicine, Kobe, Japan
| | - Kazuya Tokita
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Eijitsu Ryo
- Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Fumihiko Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Madoka Kondo
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Yota Ikegami
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology - Head and Neck Surgery, Kobe University, School of Medicine, Kobe, Japan
| | - Naoki Otsuki
- Department of Otolaryngology - Head and Neck Surgery, Kobe University, School of Medicine, Kobe, Japan
| | - Nobuyoshi Hiraoka
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan.,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology - Head and Neck Surgery, Kobe University, School of Medicine, Kobe, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Taisuke Mori
- Department of Pathology, National Cancer Center Hospital, Tokyo, Japan. .,Division of Molecular Pathology, National Cancer Center Research Institute, Tokyo, Japan.
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Yaprak Bayrak B, Kaçar Özkara S. Fine needle aspiration of non-thyroidal head and neck masses: Correlation of the cyto-histopathological diagnoses, causes of inconsistency and traps. Ann Diagn Pathol 2019; 39:15-20. [PMID: 30597402 DOI: 10.1016/j.anndiagpath.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 12/08/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Büşra Yaprak Bayrak
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
| | - Sevgiye Kaçar Özkara
- Department of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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6
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Koch EM, Fazel A, Hoffmann M. Cystic masses of the lateral neck – Proposition of an algorithm for increased treatment efficiency. J Craniomaxillofac Surg 2018; 46:1664-1668. [DOI: 10.1016/j.jcms.2018.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/16/2018] [Accepted: 06/05/2018] [Indexed: 12/23/2022] Open
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Chen AL, Renshaw AA, Faquin WC, Alexander EK, Heller HT, Cibas ES. Thyroid FNA biopsies comprised of abundant, mature squamous cells can be reported as benign: A cytologic study of 18 patients with clinical correlation. Cancer Cytopathol 2018; 126:336-341. [PMID: 29634853 DOI: 10.1002/cncy.21976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/07/2018] [Accepted: 01/11/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND A thyroid nodule comprised almost exclusively of mature, benign-appearing squamous cells is an uncommon finding in fine-needle aspiration (FNA) biopsies of thyroid nodules. Reporting such specimens was not originally addressed by The Bethesda System for Reporting Thyroid Cytopathology. The authors correlated the biologic behavior of the specimens with their benign cytologic appearance through clinical, radiographic, and surgical follow-up. METHODS The pathology archives of 3 tertiary hospitals were searched for thyroid FNA specimens consisting of mature squamous cells without atypia. The authors reviewed all available slides and included only cases that were moderately to highly cellular; nucleated or anucleate squamous cells without atypia comprised the vast majority of the cellularity. Available clinical information and/or thyroid ultrasound examination(s) were reviewed by an endocrinologist or radiologist, respectively. RESULTS A total of 18 patients (7 men and 11 women; age range, 19-76 years) with 20 nodules met the prespecified inclusion criteria. The average nodule size was 2.1 cm. Common sonographic characteristics included a well-defined appearance, the lack of internal vascularity, a thin outer wall, general hypoechogenicity with low-intermediate internal echoes, and posterior acoustic enhancement. Clinical and radiographic follow-up (mean, 3.8 years; range, <1 to 9 years) was available for 9 patients, and all nodules were stable. All 4 cases with histologic follow-up were benign squamous-lined cysts. CONCLUSIONS The findings of the current study suggest that thyroid FNA specimens comprised almost exclusively of mature squamous cells can be reported as benign. Cancer Cytopathol 2018;126:336-41. © 2018 American Cancer Society.
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Affiliation(s)
- Athena L Chen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew A Renshaw
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida.,Department of Pathology, Miami Cancer Institute, Miami, Florida
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- Endocrinology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Howard T Heller
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Soft Palate Pleomorphic Adenoma of a Minor Salivary Gland: An Unusual Presentation. Case Rep Otolaryngol 2018; 2018:3986098. [PMID: 29808148 PMCID: PMC5902113 DOI: 10.1155/2018/3986098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/12/2018] [Indexed: 11/22/2022] Open
Abstract
Approximately 10% of pleomorphic adenomas occur in the minor salivary glands with the palate being the most common site. Pleomorphic adenomas account for the majority of palatal tumours; however, minor salivary gland tumours have a higher risk of malignancy compared to tumours of the major salivary glands, so appropriate diagnostic evaluation should be prompt. We present a case of a 52-year-old man with a longstanding history of a soft palate pleomorphic adenoma which required excision under general anaesthetic via a mandibular swing approach. As well as the surgical approach to access this tumour; this case is unique as it is the largest soft palate pleomorphic adenoma reported in the literature. We discuss the appropriate preoperative investigations and airway considerations for this patient, as well as the factors to consider when planning operative management of palatal tumours.
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9
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Galed-Placed I, Teijo-Quintáns A, Pombo-Otero J, Veiga-Barreiro A. Parotid cyst due to sialolithiasis masquerading as pilomatrixoma on FNA. Cytopathology 2016; 28:174-176. [PMID: 27943427 DOI: 10.1111/cyt.12403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- I Galed-Placed
- Servicio de Anatomía Patológica, Sección de Citología, Complexo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | - A Teijo-Quintáns
- Servicio de Anatomía Patológica, Sección de Citología, Complexo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | - J Pombo-Otero
- Servicio de Anatomía Patológica, Sección de Citología, Complexo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
| | - A Veiga-Barreiro
- Servicio de Anatomía Patológica, Sección de Citología, Complexo Hospitalario Universitario A Coruña (CHUAC), La Coruña, Spain
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10
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Abstract
Common usage of fine-needle aspirate (FNA) for salivary gland lesions is the preoperative determination of whether a lesion is neoplastic, its lineage, and if neoplastic, whether it is low grade/benign, or high grade. Immunohistochemical stains can be performed on cell blocks to determine lineage and help refine diagnosis, although their performance is not always equivalent to that seen in surgical specimens. Several characteristic translocations have been described in various entities in these categories, and these can be evaluated using fluorescence in situ hybridization. In the future, high-throughput next-generation sequencing panels may further refine cytologic diagnosis in salivary tumors.
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Affiliation(s)
- Raja R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, A614.X PUH, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
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11
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Green B, Rahimi S, Brennan PA. Current management of the neck in salivary gland carcinomas. J Oral Pathol Med 2016; 46:161-166. [DOI: 10.1111/jop.12458] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2016] [Indexed: 01/12/2023]
Affiliation(s)
- Ben Green
- Department of Gastroenterology; Torbay Hospital; Torquay UK
| | - Siavash Rahimi
- Department of Histopathology; Queen Alexandra Hospital; Portsmouth UK
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Amita K, Vijay Shankar S, Sanjay M, Sarvesh BM. Effectiveness of the Pattern-Based Approach in the Cytodiagnosis of Salivary Gland Lesions. Acta Cytol 2016; 60:107-17. [PMID: 27161013 DOI: 10.1159/000445521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/16/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study is to investigate, primarily, the effectiveness of the application of pattern-based analysis in the diagnosis of salivary gland (SG) lesions. Secondarily, an attempt was made to study the cytomorphology of the various lesions in detail and discuss the pitfalls and solutions involved in the challenging conditions at cytology. MATERIALS AND METHODS This was a prospective, cross-sectional study. All SG lesions over 2 years were subjected to fine-needle aspiration cytology with patients' prior informed consent. The lesions were classified based on the predominant pattern, and a provisional diagnosis was made. The secondary pattern and other features, such as background, were then taken note of, and a combined cytological diagnosis was rendered. The entire spectrum of lesions was divided into 6 morphological categories. RESULTS We had a total of 72 SG lesions. The most commonly affected gland was the parotid gland in 79.16% (57/72) of the cases. Surgery was performed in 26 cases (36.11%). A concordant diagnosis was obtained in 22 cases. The sensitivity, specificity and diagnostic accuracy by the pattern-based approach was 75, 100 and 88.46%, respectively. There were no false-positive cases, but 2 false-negative cases were recorded. CONCLUSION The precise cytological preoperative diagnosis of SG lesions is important for the management of patients. The pattern-based approach can be used routinely in the cytological diagnosis of SG lesions.
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Affiliation(s)
- K Amita
- Department of Pathology, Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, India
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13
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Negahban S, Shirian S, Khademi B, Oryan A, Sadoughifar R, Mohammad MP, Aledavood A, Daneshbod K, Daneshbod Y. The Value of Ultrasound-Guided Fine-Needle Aspiration Cytology by Cytopathologists in the Diagnosis of Major Salivary Gland Tumors. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479316634320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Because of the typical sonographic appearances of many salivary gland masses, as well as the normal appearance and anatomy of the glands, differentiation of salivary glands tumors based only on clinical and imaging criteria is difficult. We compared the utility, safety, specificity, and accuracy of ultrasound-guided fine needle aspiration cytology (UG-FNAC) in the detection of nonpalpable tumors in the major salivary glands. A retrospective review was done of a 5-year experience of 102 consecutive patients undergoing UG-FNAC. Clinical opinion, FNA results, and final pathologic findings were examined. Histological evaluation showed 29 malignant tumors and 54 benign lesions (neoplasms and nonneoplastic lesions). The cytologic findings were nondiagnostic in 19 cases (18.6%), true negative in 50 (49%), true positive in 20 (19.6%), false negative in 9 (8.8%), and false-positive in 4 (3.9%) cases for detecting malignant tumors. Six of 20 (30%) malignant tumors (true positive) and 41 of 50 (82%) benign lesions (true negative) were classified accurately. The accuracy, sensitivity, and specificity were 84.3%, 68.9%, and 92.6%, respectively. Ultrasound guided FNAC was found to be highly specific for malignancy and its sensitivity for malignancy was good. It is a reliable and accurate diagnostic technique with minimal complications and easy to perform with high specificity 92.5% (95% CI: 82.09%-97.90%). It should be the preferred primary approach for initial investigation in diagnosing salivary gland tumors.
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Affiliation(s)
- Shahrzad Negahban
- Shiraz Molecular Pathology Research Center, Daneshbod Pathology Laboratory, Shiraz, Iran
| | - Sadegh Shirian
- Department of Pathology, School of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
- Shefa Neuroscience Research Center, Khatam-Al-Anbia Hospital, Tehran, Iran
- Brain and Spinal Cord Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bijan Khademi
- Head and Neck Cancer, Endoscopic Sinus Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Oryan
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz Iran
| | - Roshanak Sadoughifar
- Department of Pathology, School of Veterinary Medicine, Shiraz University, Shiraz Iran
| | | | - Azita Aledavood
- Shiraz Molecular Pathology Research Center, Daneshbod Pathology Laboratory, Shiraz, Iran
| | - Khosrow Daneshbod
- Shiraz Molecular Pathology Research Center, Daneshbod Pathology Laboratory, Shiraz, Iran
| | - Yayha Daneshbod
- Shiraz Molecular Pathology Research Center, Daneshbod Pathology Laboratory, Shiraz, Iran
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14
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Mohammed Nur M, Murphy M. Adequacy and accuracy of salivary gland fine needle aspiration cytology. Ir J Med Sci 2015; 185:711-716. [DOI: 10.1007/s11845-015-1352-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 08/30/2015] [Indexed: 10/23/2022]
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15
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Novoa E, Gürtler N, Arnoux A, Kraft M. Diagnostic value of core needle biopsy and fine-needle aspiration in salivary gland lesions. Head Neck 2015; 38 Suppl 1:E346-52. [DOI: 10.1002/hed.23999] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Eva Novoa
- Department of Otorhinolaryngology; Head and Neck Surgery; Kantonsspital AG; Aarau Switzerland
| | - Nicolas Gürtler
- Department of Otorhinolaryngology; Head and Neck Surgery; University Hospital of Basel; Basel Switzerland
| | - André Arnoux
- Department of Otorhinolaryngology; Head and Neck Surgery; Kantonsspital AG; Aarau Switzerland
| | - Marcel Kraft
- Department of Otorhinolaryngology; Head and Neck Surgery; Kantonsspital Baselland; Liestal Switzerland
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16
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Malzone MG, Campanile AC, Losito NS, Longo F, Perri F, Caponigro F, Schiavone C, Ionna F, Maiello F, Martinuzzi C, Nasti S, Botti G, Fulciniti F. Brooke-Spiegler syndrome presenting multiple concurrent cutaneous and parotid gland neoplasms: Cytologic findings on fine-needle sample and description of a novel mutation of the CYLD gene. Diagn Cytopathol 2015; 43:654-8. [DOI: 10.1002/dc.23275] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/09/2015] [Accepted: 03/30/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Maria Gabriella Malzone
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
| | - Anna Cipolletta Campanile
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
| | - Nunzia Simona Losito
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
| | - Francesco Longo
- S.C Di Chirurgia Maxillo-Facciale ORL, Istituto Nazionale Tumori “Fondazione G. Pascale,”; Napoli Italy
| | - Francesco Perri
- Medical Oncology Unit, Presidio Ospedaliero Centrale “SS Annunziata,”; Taranto Italy
| | - Francesco Caponigro
- S.C. Di Oncologia Medica Testa Collo E Sarcomi, Istituto Nazionale Tumori “Fondazione G. Pascale,”; Napoli Italy
| | - Concetta Schiavone
- S.C. Di Radioterapia, Istituto Nazionale Tumori “Fondazione G. Pascale,”; Napoli Italy
| | - Franco Ionna
- S.C Di Chirurgia Maxillo-Facciale ORL, Istituto Nazionale Tumori “Fondazione G. Pascale,”; Napoli Italy
| | - Francesco Maiello
- Servizio Di Anatomia, Istologia Patologica E Citopatologia, Presidio Ospedaliero Dei Pellegrini; Napoli Italy
| | - Claudia Martinuzzi
- Dipartimento Di Medicina Interna E Specialità Mediche; Università Di Genova; Genova Italy
| | - Sabina Nasti
- Dipartimento Di Medicina Interna E Specialità Mediche; Università Di Genova; Genova Italy
| | - Gerardo Botti
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
| | - Franco Fulciniti
- Istituto Nazionale Tumori “Fondazione G. Pascale,”, S.S.D. Di Citopatologia E S.C Di Anatomia Patologica; Napoli Italy
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17
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Fine needle aspiration cytology versus frozen section in branchial cleft cysts. The Journal of Laryngology & Otology 2015; 129:174-8. [PMID: 25684337 DOI: 10.1017/s0022215115000067] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Branchial cleft cysts occur because of a failure of involution of the second branchial cleft. However, as well-differentiated squamous cell carcinoma can mimic branchial cleft cysts, there is a lack of consensus on the appropriate management of cystic neck lumps. OBJECTIVE To report our experience of fine needle aspiration cytology and frozen section examination in the management of cystic neck lumps. METHOD Retrospective case note review of patients managed in the Southern General Hospital, Scotland, UK. RESULTS The sensitivity of fine needle aspiration cytology and frozen section for detecting branchial cleft cysts was 75 per cent and 100 per cent respectively. Two patients who did not undergo intra-operative frozen section examination were either over- or under-treated, which is discussed. CONCLUSION Adult patients subjected to surgical excision of a suspected branchial cyst should undergo intra-operative frozen section analysis regardless of clinical suspicion for malignancy. This part of management is critical to ensure patients are offered appropriate treatment.
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Ahn D, Kim H, Sohn JH, Choi JH, Na KJ. Surgeon-performed ultrasound-guided fine-needle aspiration cytology of head and neck mass lesions: sampling adequacy and diagnostic accuracy. Ann Surg Oncol 2014; 22:1360-5. [PMID: 25297899 DOI: 10.1245/s10434-014-4119-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Studies of surgeon-performed ultrasound-guided fine-needle aspiration cytology (US-FNAC) have been limited largely to thyroid nodules. This study evaluated the sampling adequacy and diagnostic accuracy of surgeon-performed US-FNAC for a large range of head and neck mass lesions, including lesions of the thyroid, salivary glands, and lymph nodes. METHODS The study included 617 cases of US-FNAC performed by a single surgeon between 2009 and 2013. Their medical histories and ultrasound (US) findings were retrospectively reviewed. Sample adequacy was analyzed according to the surgeon's experience, anatomic tumor location, and US tumor characteristics. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of FNAC were calculated after correlation with the surgical histopathologic results. RESULTS The overall adequacy rate for surgeon-performed US-FNAC was 91.9 % (567/617). Inadequate specimens were obtained from 9.7 % (29/282) of the thyroid glands, 6.1 % of the salivary glands (6/98), and 6.3 % (15/237) of the lymph nodes. The effect of the surgeon's experience plateaued (inadequate sampling rate, 6-8 %) after 100 US-FNAC procedures. Inadequate sampling was associated with tumor characteristics such as cystic change and rim calcification. Overall, US-FNAC showed a sensitivity of 88.2 %, a specificity of 98.2 %, a PPV of 98.5 %, an NPV of 85.7 %, and a diagnostic accuracy of 91.6 %. CONCLUSION With proper training and experience managing at least 100 US-FNAC cases, surgeons can ensure a low inadequate sampling rate and good diagnostic accuracy for a range of head and neck mass lesions.
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Affiliation(s)
- Dongbin Ahn
- Department of Otolaryngology-Head and Neck Surgery, Kyungpook National University, Daegu, Korea,
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Khan N, Afroz N, Haider A, Hassan MJ, Hashmi SH, Hasan SA. Role of fine needle aspiration, imprint and scrape cytology in the evaluation of intraoral lesions. J Cytol 2014; 30:263-9. [PMID: 24648671 PMCID: PMC3945628 DOI: 10.4103/0970-9371.126661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: The primary goal of our study was to evaluate the value and accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of various intraoral lesions and to correlate the cytological diagnosis with final histopathological findings. Materials and Methods: Fine needle aspiration was performed in 229 patients presented with different lesions of the oral cavity at our institution. Cytological findings were then compared with final histopathological diagnosis. Results: With a male to female ratio of 1.79:1, 229 patients presented with different lesions of the oral cavity were aspirated. Histopathological correlation was available in 86.9% of cases while inadequate material was obtained in 13.1% cases. The diagnostic accuracy of fine needle aspiration in diagnosing benign, pre-malignant and malignant lesions were 95.8%, 84.6% and 97% respectively. Overall the diagnostic accuracy of FNAC in diagnosing intraoral lesions was 94.9% with sensitivity and specificity of 93.2% and 96.8% respectively. Conclusion: FNAC of intraoral lesion is recommended as a valuable procedure for the initial evaluation of all intraoral lesions as it is simple, inexpensive, convenient and comfortable to the patient. Moreover, it can offer a rapid and accurate diagnosis for further management of the patient.
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Affiliation(s)
- Nazoora Khan
- Department of Pathology, J.N. Medical College, Aligarh, Uttar Pradesh, India
| | - Nishat Afroz
- Department of Pathology, J.N. Medical College, Aligarh, Uttar Pradesh, India
| | - Aiman Haider
- Department of Pathology, J.N. Medical College, Aligarh, Uttar Pradesh, India
| | - Mohd Jaseem Hassan
- Department of Pathology, J.N. Medical College, Aligarh, Uttar Pradesh, India
| | - Sarwat Hussain Hashmi
- Department of Oral and Maxillofacial Surgery, Dr. Z.A. Dental College, A.M.U., Aligarh, Uttar Pradesh, India
| | - Syed Abrar Hasan
- Department of Otorhinolaryngology, J.N. Medical College, Aligarh, Uttar Pradesh, India
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Mallon DH, Kostalas M, MacPherson FJ, Parmar A, Drysdale A, Chisholm E, Sadek S. The diagnostic value of fine needle aspiration in parotid lumps. Ann R Coll Surg Engl 2013; 95:258-62. [PMID: 23676809 PMCID: PMC4132499 DOI: 10.1308/003588413x13511609958370] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Fine needle aspiration (FNA) is a safe and quick method of diagnosing superficial lumps, which aids preoperative planning. However, FNA of the parotid gland has not gained the widespread acceptance noted in other head and neck lumps. The aim of this study was to determine the ability of FNA of the parotid gland to differentiate benign and malignant disease, and to determine the impact on surgical outcome. METHODS A retrospective analysis of 201 consecutive parotid operations with preoperative FNA in a large district hospital in the UK was performed. The diagnostic characteristics were calculated for benign and malignant disease, and the impact on surgical procedure was determined. RESULTS In identifying benign disease, FNA has a sensitivity of 85% and a specificity of 76%. In detecting malignant disease, FNA has a sensitivity and specificity of 52% and 92% respectively. A false positive on FNA was associated with a higher incidence of neck dissection. CONCLUSIONS FNA is a useful diagnostic test. However, owing to low sensitivity, it is necessary to interpret it in the context of all other clinical information.
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Affiliation(s)
- D H Mallon
- Cambridge University Hospitals NHS Foundation Trust, UK.
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Liu T, Gao JF, Yi YX, Ding H, Liu W. Misdiagnosis of left supraclavicular lymph node metastasis of hepatocellular carcinoma: A case report. World J Gastroenterol 2013; 19:960-963. [PMID: 23429993 PMCID: PMC3574897 DOI: 10.3748/wjg.v19.i6.960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 12/05/2012] [Accepted: 01/12/2013] [Indexed: 02/06/2023] Open
Abstract
Left supraclavicular lymph node metastasis is a rare presentation of hepatocellular carcinoma (HCC). This phenomenon is easily neglected in the clinic. A 56-year-old man presented with HCC. On examination, a 1cm long left supraclavicular lymph node was palpated. Auxiliary examination indicated a lesion located in the right lobe of the liver. Fine needle aspiration cytology (FNAC) of the enlarged lymph node was performed; however, only necrosis was found. Hepatectomy was performed and HCC was confirmed by Hematoxylin-Eosin staining. However, 14 d after surgery, significantly enlarged left supraclavicular lymph nodes, a new intrahepatic lesion, and pulmonary and mediastinal metastasis appeared. An excisional biopsy of the left supraclavicular lymph node was performed, and its findings confirmed metastatic HCC. The patient’s HCC rapidly progressed and he died one month later. It is possible for HCC to metastasize to the left supraclavicular lymph node. Surgeons should always consider an overall physical examination. When left supraclavicular lymphadenopathy of unknown origin is encountered, FNAC should be performed initially. If the results are negative, an excisional biopsy and subsequent Positron emission tomography - computed tomography scanning should be performed. These are very important for making the correct diagnosis and for selecting reasonable therapies.
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Kalmar JR. Advances in the detection and diagnosis of oral precancerous and cancerous lesions. Oral Maxillofac Surg Clin North Am 2012; 18:465-82. [PMID: 18088846 DOI: 10.1016/j.coms.2006.06.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- John R Kalmar
- Section of Oral and Maxillofacial Surgery, Pathology, and Anesthesiology, The Ohio State University College of Dentistry, 305 West 12th Avenue, Columbus, OH 43210, USA
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Abstract
OBJECTIVE The purpose of this study was to determine the performance of real-time sonoelastography in the differential diagnosis of salivary gland tumors. SUBJECTS AND METHODS Between 2007 and 2010, 74 salivary gland tumors were examined by ultrasound and sonoelastography in 66 patients. Lesions were graded according to a 4-point elastography score. Surgical excision and histopathologic examination were performed in all cases. The difference in elastographic score between benign and malignant masses and that between pleomorphic adenomas and Warthin tumors were evaluated. RESULTS Of the 74 salivary tumors, 63 were located in the parotid, and 11 were in the submandibular gland. There were 18 malignant and 56 benign tumors. The mean (± SD) elastographic score was 2.58 ± 0.87 for pleomorphic adenomas, 2.15 ± 0.80 for Warthin tumors, 2.00 ± 0.57 for other benign tumors, and 2.94 ± 0.87 for malignant tumors. For benign tumors overall, the mean elastographic score was 2.41 ± 0.87. The difference in elastographic score between benign and malignant tumors overall was statistically significant (p < 0.05), but the difference between malignant tumors and pleomorphic adenomas and that between Warthin tumors and pleomorphic adenomas were not statistically significant. Using cutoff values between scores 2 and 3 and scores 3 and 4, there was no statistically significant difference between benign and malignant tumors. CONCLUSION Although this study revealed a difference in elastographic score between benign and malignant tumors, detailed analysis did not provide consistent results. Consequently, real-time sonoelastography appears to be a limited technique in the differential diagnosis between benign and malignant salivary masses.
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Peltola JC, Samad A, Pambuccian SE. Granulation tissue associated with a ruptured epidermal inclusion cyst: a potential pitfall in fine needle aspirates of neck masses. Diagn Cytopathol 2011; 41:344-7. [PMID: 22144137 DOI: 10.1002/dc.22808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 10/30/2011] [Indexed: 11/09/2022]
Affiliation(s)
- Justin C Peltola
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Baloch ZW, Segal JP, Livolsi VA. Unique growth pattern in papillary carcinoma of the thyroid gland mimicking adenoid cystic carcinoma. Endocr Pathol 2011; 22:200-5. [PMID: 21863325 DOI: 10.1007/s12022-011-9174-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We report here three cases of papillary thyroid carcinoma (PTC) with hyaline globules as seen in adenoid cystic carcinoma of the salivary glands. This unique growth pattern was seen in two cases of columnar cell and one case of cribriform morular variant of PTC. Fine-needle aspiration was performed in two cases. By immunohistochemistry, all cases demonstrated expression of TTF-1 and thyroglobulin confirming follicular cell derivation. It is important to be aware of this unusual growth pattern in thyroid carcinomas; immunohistochemistry is warranted for rendering accurate cytopathologic and histopathologic diagnosis.
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Affiliation(s)
- Zubair W Baloch
- Department of Pathology & Laboratory Medicine, University of Pennsylvania Medical Center, 6 Founders Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Singh Nanda KD, Mehta A, Nanda J. Fine-needle aspiration cytology: a reliable tool in the diagnosis of salivary gland lesions. J Oral Pathol Med 2011; 41:106-12. [PMID: 21883485 DOI: 10.1111/j.1600-0714.2011.01069.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) is used as the main initial diagnostic investigation for lumps in the head and neck region. Major salivary glands and some minor salivary glands are easily accessible; therefore, they are optimal targets for FNAC. The aim of this study was to discuss the advantages and pitfalls of FNAC as compared to histopathology in the salivary gland lesions. MATERIAL AND METHODS A total of 127 FNAC were carried out on salivary gland lesions from January 2006 to December 2010--a 5-year period. Histopathological follow-up data were obtained in 56 cases. The study was conducted to examine the sensitivity, specificity, and accuracy of FNAC for salivary gland swellings in comparison with histopathology. RESULTS The male-to-female ratio was 2.4:1. Parotid gland was involved in 51.1%, submandibular gland in 37%, sublingual gland in 4.7%, and minor salivary glands in 7% of patients. There were 55.9% cases of non-neoplastic lesions and 44.1% cases of neoplastic lesions on biopsy. Sensitivity, specificity, positive predictive value, and negative predictive value of FNAC for malignant neoplastic lesions were 84.61%, 86.48%, 68.75%, and 94.11%, respectively, whereas for benign neoplastic lesions, they were 84.61%, 91.66%, 91.6%, and 85%, respectively. CONCLUSION Fine-needle aspiration cytology is found to be a good sensitive and specific technique for the diagnosis of most of the salivary gland lesions. FNAC should be adopted as an initial investigation for all salivary gland swellings in conjunction with other investigations where appropriate.
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Vicandi B, Jiménez-Heffernan JA, López-Ferrer P, González-Peramato P, Patrón M, Viguer JM. Fine needle aspiration cytology of basal cell adenoma of the salivary gland: a cytohistological correlation study of 35 cases. Cytopathology 2011; 23:315-9. [PMID: 21838722 DOI: 10.1111/j.1365-2303.2011.00899.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE In order to evaluate the possibility of a specific cytological recognition of basal cell adenoma (BCA) we reviewed our experience with 35 histologically proven cases. Few series describing cytological features of BCA are available and diagnostic cytological criteria are not well established. METHODS This study was based on 41 cytology samples from 35 patients with BCA. Thirty-five aspiration procedures were performed pre-operatively and six on tumour recurrence. Nineteen of the 35 patients were men and 16 women. The mean age at diagnosis was 55 years old (range 24-92). The series includes one non-representative case. Except for one tumour located in the upper lip, all of them involved the parotid gland. RESULTS Aspirates were cellular, showing groups with dense, homogeneous metachromatic stroma and single cells. Relevant features were the trident-like configuration of groups, intimate relationship between neoplastic cells and stroma and cellular polymorphism. In approximately half of the cases a precise diagnosis was given. Most of the remaining tumours were diagnosed as benign but they were difficult to differentiate from pleomorphic adenoma. Regarding malignancy, there were two misdiagnoses of acinic cell carcinoma, due to high epithelial cellularity along with scarcity of stroma, and one case was considered to be suspicious of malignancy. CONCLUSION BCA shows characteristic cytological features that allow a precise diagnosis. The main differential diagnosis is epithelial-rich pleomorphic adenoma, while acinic cell carcinoma is a potential false positive.
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Affiliation(s)
- B Vicandi
- Department of Pathology, University Hospital La Paz, Madrid, Spain
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Gahine R, Sudarshan V, Hussain N, Krishnani C. Pleomorphic adenoma: A diagnostic pitfall in the diagnosis of salivary gland lesions on FNAC: Case reports with review of the literature. Cytojournal 2010; 7:17. [PMID: 20976206 PMCID: PMC2955342 DOI: 10.4103/1742-6413.70406] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Accepted: 06/03/2010] [Indexed: 11/09/2022] Open
Abstract
Fine needle aspiration cytology (FNAC) is commonly being used with increasing frequency for the pre-operative evaluation of salivary gland lesions. However, it has areas of considerable interpretational difficulties. The most frequent problems involve variations in the expected cytology of pleomorphic adenoma (PA). Salivary gland FNACs performed at Pt. JNM Medical College, Raipur, Chhattisgarh, during July 2006 to June 2007 were reviewed, and we report four cases of interesting diagnostic dilemma. As PA is the most common salivary gland neoplasm, it should always be considered and ruled out as the first differential in the diagnosis of salivary gland FNACs. In order to avoid diagnostic pitfalls, we emphasize a diagnostic approach based on the mandatory presence of all three elements of PA, i.e. 3-dimensional cohesive clusters of ductal cells, background of singly lying plasmacytoid myoepithelial cells and dense fibrillary brightly metachromatic stroma with partially obscured entrapped myoepithelial cells. To document the same, we advocate liberal use of repeat aspirations with multiple sampling performed from different parts of the tumor. Some differential diagnostic problems, e.g. carcinoma ex PA, may still however remain insolvable by cytologic means.
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Affiliation(s)
- Renuka Gahine
- Department of Pathology, Pt. JNM Medical College, Raipur, Chhattisgarh, India
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David D, Clayman L, Saleh H. Value of fine-needle aspiration biopsy in initial evaluation of floor of the mouth masses: report of a case of low-grade mucoepidermoid carcinoma. Diagn Cytopathol 2010; 38:81-4. [PMID: 19688766 DOI: 10.1002/dc.21163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Low-grade mucoepidermoid carcinoma (LG MEC) is a rare tumor which can occur in the minor salivary glands as intraoral lesion, more frequently in the palate and very rarely in the floor of the mouth. Traditionally, the diagnosis has been made on surgical resection specimens only. There is new growing evidence that these lesions can be accurately diagnosed by a fine-needle aspiration (FNA) biopsy procedure. In this article, we report a case of LG MEC of the floor of mouth diagnosed by FNA and confirmed by subsequent surgical resection. We also provide clues for high index of suspicion for these rare lesions, both clinically and morphologically.
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Affiliation(s)
- Doina David
- Department of Pathology, Sinai-Grace Hospital/Detroit Medical Center, Wayne State University School of Medicine, Detroit, Michigan 48235, USA.
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Fine needle aspiration cytology (FNAC) of salivary gland tumours: Repeat aspiration provides further information in cases with an unclear initial cytological diagnosis. Br J Oral Maxillofac Surg 2010; 48:26-9. [DOI: 10.1016/j.bjoms.2008.12.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2008] [Indexed: 11/18/2022]
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Jan IS, Chung PF, Weng MH, Huang MS, Lee YT, Cheng TY, Ko JY, Kuo SH. Analysis of fine-needle aspiration cytology of the salivary gland. J Formos Med Assoc 2008; 107:364-70. [PMID: 18492620 DOI: 10.1016/s0929-6646(08)60101-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND/PURPOSE Fine needle aspiration (FNA) cytology has been widely accepted as a safe method for diagnosis of salivary gland lesions. This study investigated the accuracy of FNA cytology of salivary gland lesions by correlation between histology and cytology. METHODS One hundred and thirty-one archived salivary gland FNA specimens collected between January 1994 and December 2002 from 131 patients were correlated with histopathology findings. The major reasons for false-negative and false-positive results in cytologic diagnosis were determined. RESULTS Considering the results of histopathology as the diagnostic standard, the sensitivity of FNA cytology in diagnosing malignancy was 74% (17/23) after excluding two cases which had a cytodiagnosis of suspicion of malignancy. Excluding eight cases that had a cytodiagnosis of suspicion of malignancy, the diagnostic specificity was 99% (97/98). There were six false-negative and one false-positive cases. CONCLUSION This study demonstrated that FNA cytology of the salivary gland is a useful technique for diagnosis of salivary gland lesions. Inadequate labeling of the aspiration sites and insufficient cellularity were the most important factors that resulted in incorrect cytologic interpretation.
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Affiliation(s)
- I-Shiow Jan
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Tandon S, Shahab R, Benton JI, Ghosh SK, Sheard J, Jones TM. Fine-needle aspiration cytology in a regional head and neck cancer center: Comparison with a systematic review and meta-analysis. Head Neck 2008; 30:1246-52. [DOI: 10.1002/hed.20849] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Netto JDNS, Miranda ÁMMA, da Silveira HM, dos Santos TCRB, Pires FR. Fine-needle aspiration biopsy as an auxiliary diagnostic tool on intraoral minor salivary gland adenoid cystic carcinoma. ACTA ACUST UNITED AC 2008; 106:242-5. [DOI: 10.1016/j.tripleo.2008.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Revised: 04/13/2008] [Accepted: 04/17/2008] [Indexed: 10/21/2022]
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Saleh HA, Clayman L, Masri H. Fine needle aspiration biopsy of intraoral and oropharyngeal mass lesions. Cytojournal 2008; 5:4. [PMID: 18373853 PMCID: PMC2329665 DOI: 10.1186/1742-6413-5-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Accepted: 03/28/2008] [Indexed: 11/19/2022] Open
Abstract
Background Fine needle aspiration (FNA) biopsy has been rarely used in oral and oropharyngeal lesions. The goal of this study was to assess the value and accuracy of FNA biopsy in the diagnosis of oral and oropharyngeal lesions particularly in regards to discriminating benign from malignant tumors. Methods Sixteen cases of FNA biopsies obtained of various intraoral and oropharyngeal masses or lesions performed at our institution during the eight-year period from 1998 to 2006 were retrospectively reviewed. The aspiration cytologic diagnoses were correlated with the histologic examination of the corresponding resected lesions. Results Sixteen cases of intraoral lesions evaluated by FNA biopsies during the period of 1998–2006 were reviewed. The sites of involvement were: lip [1], maxillary sinus [3], pharynx/oropharynx [5], floor of mouth [4], buccal mucosa [2] and peritonsillar area [1]. Patients' age ranged from 30 to 87 with an average of 54 years. Male to female ratio was 1:3. Cytologically, 7 cases were diagnosed as suspicious/malignant, and 9 cases as benign (including 6 benign neoplasm, 1 atypical, and 2 reactive or "descriptive"). Fifteen cases had corresponding surgical resection for histologic examination, of these, 9 cases were interpreted as malignant, and 6 as benign. There were no false positive diagnoses of malignancy on FNA. Two cases were interpreted as benign or atypical cytologically, but were found to be malignant on histologic examination. Conclusion FNA biopsy of intraoral and oropharyngeal masses is a valuable procedure for the initial evaluation of various lesions. It provides helpful information about these lesions and avoids hasty or unnecessary surgical biopsy. It is a rapid and relatively noninvasive procedure. Furthermore, aspiration biopsy is an important tool in the diagnosis and management of these lesions, both neoplastic and non-neoplastic, and can be sometimes complemented by ancillary studies for more accurate interpretation. However, its sensitivity in the diagnosis of malignancy is lower than that of histologic samples. This is probably due to the superficial nature and small size of these lesions, the limited space for maneuvering the needle and difficulty in immobilizing the lesion to obtain adequate samples, rather than to interpretation or inherent limitations of the technique itself.
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Affiliation(s)
- Husain A Saleh
- Department of Pathology, Sinai-Grace Hospital/Detroit Medical Center, Wayne State University, Detroit, Michigan, USA.
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Di Palma S, Lambros MBK, Savage K, Jones C, Mackay A, Dexter T, Iravani M, Fenwick K, Ashworth A, Reis-Filho JS. Oncocytic change in pleomorphic adenoma: molecular evidence in support of an origin in neoplastic cells. J Clin Pathol 2007; 60:492-9. [PMID: 16467165 PMCID: PMC1994546 DOI: 10.1136/jcp.2005.031369] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2005] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cells with oncocytic change (OC) are a common finding in salivary glands (SGs) and in SG tumours. When found within pleomorphic adenomas (PAs), cells with OC may be perceived as evidence of malignancy, and lead to a misdiagnosis of carcinoma ex pleomorphic adenoma (CaExPa). AIM To describe a case of PA with atypical OC, resembling a CaExPa. A genomewide molecular analysis was carried out to compare the molecular genetic features of the two components and to determine whether the oncocytic cells originated from PA cells, entrapped normal cells, or whether these cells constitute an independent tumour. MATERIALS AND METHODS Representative blocks were immunohistochemically analysed with antibodies raised against cytokeratin (Ck) 5/6, Ck8/18, Ck14, vimentin, p63, alpha-smooth muscle actin (ASMA), S100 protein, anti-mitochondria antibody, beta-catenin, HER2, Ki67, p53 and epidermal growth factor receptor. Typical areas of PA and OC were microdissected and subjected to microarray-based comparative genomic hybridisation (aCGH). Chromogenic in situ hybridisation (CISH) was performed with in-house generated probes to validate the aCGH findings. RESULTS PA cells showed the typical immunohistochemical profile, including positivity for Ck5/6, Ck8/18, Ck14, vimentin, ASMA, S100 protein, p63, epidermal growth factor receptor and beta-catenin, whereas oncocytic cells showed a luminal phenotype, expression of anti-mitochondria antibody and reduced beta-catenin staining. Both components showed low proliferation rates and lacked p53 reactivity. aCGH revealed a similar amplification in both components, mapping to 12q13.3-q21.1, which was further validated by CISH. No HER2 gene amplification or overexpression was observed. The foci of oncocytic metaplasia showed an additional low-level gain of 6p25.2-p21.31. CONCLUSION The present data demonstrate that the bizarre atypical cells of the present case show evidence of clonality but no features of malignancy. In addition, owing to the presence of a similar genome amplification pattern in both components, it is proposed that at least in some cases, OC may originate from PA cells.
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Affiliation(s)
- Silvana Di Palma
- Royal Surrey County Hospital, University of Surrey, Guildford, UK
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Abstract
BACKGROUND It seems that the choice of the treatment modalities for parotid gland tumors frequently depends on personal experience more than on evidence-based criteria. A nationwide survey was conducted to obtain an overview of current practice in German ENT hospitals. METHODS A standardised questionnaire comprising 19 questions on the treatment and diagnostic methods for parotid gland tumors was sent to all ENT hospitals in Germany. RESULTS The overall return rate of the questionnaires was 128 of 170 (75%). The results confirmed highly variable strategies for the treatment of parotid gland tumors in Germany. CONCLUSION On the basis of our survey and the upcoming establishment of a German database for salivary gland cancer in Erlangen, Germany, we hope to be able to clarify controversial topics on the treatment of parotid gland tumors in the near future.
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Affiliation(s)
- S F Preuss
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenkrankheiten der Universität zu Köln, Joseph-Stelzmann-Strasse 9, 50924 Köln.
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Yang GCH, Waisman J. Distinguishing adenoid cystic carcinoma from cylindromatous adenomas in salivary fine-needle aspirates: The cytologic clues and their ultrastructural basis. Diagn Cytopathol 2006; 34:284-8. [PMID: 16544336 DOI: 10.1002/dc.20430] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The utilization of fine-needle aspiration (FNA) biopsy in salivary tumors is hindered by the reluctance of many cytopathologists to report adenoid cystic carcinoma (ACC) because its cylindromatous stroma is observed occasionally in pleomorphic adenoma (PA) and basal cell adenoma (BA), and a diagnosis of ACC results in radical surgery. The aim of this study is to identify dependable features to distinguish the look-alike entities and illustrate their ultrastructural base. We compared 20 cases of ACC to 15 cases of cylindromatous PA and 9 cases of BA. All were direct smears stained with Diff-Quik, hematoxylin and eosin, Papanicolaou, or Ultrafast Papanicolaou (UFP) stain. In addition to the presence of cylindromatous pattern, the amount of cytoplasm in the neoplastic cells and nuclear features were compared. Tissue was dissected from paraffin blocks and processed for electron microscopy in selected cases. The difference in nuclear features can be distinguished in UFP-stained smears and electron microscopy. The nuclei of ACCs were heterochromatic with coarse chromatin and irregular nucleoli, whereas the nuclei of PAs were euchromatic with fine chromatin and small compact nucleoli. The nuclei of BAs were hyperchromatic but finely textured. The cytoplasm of PAs was detectable with every stain at 40x objective, but the cytoplasm of BAs required UFP stain and 100x objective to be detected. The cytoplasm of majority of neoplastic cells of ACCs are invisible, because the thin rim of cytoplasm measured <1 microm ultrastructurally, well beyond the resolution of a light microscope. Rare cohesive fragment of epithelial cells in ACC have scanty blue cytoplasm in UFP stain and can be recognized as ductal cells. In conclusion, in our analysis of salivary tumors with a cylindromatous pattern, the seemingly naked nuclei of neoplastic cells with their coarse nuclear chromatin and irregular nucleoli, as revealed by the UFP stain, reliably distinguished ACC from cylindromatous adenomas.
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Affiliation(s)
- Grace C H Yang
- Department of Pathology, New York University School of Medicine, New York, New York, USA
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Brunings JW, Driessen A, De Jong JMA, Manni JJ. A 15-year-old girl with a spindle cell carcinoma of the parotid gland. A diagnostic challenge solved by immunohistochemistry and cytogenetic analysis. Acta Otolaryngol 2006; 126:104-7. [PMID: 16308263 DOI: 10.1080/00016480510038545] [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: 10/25/2022]
Abstract
Spindle cell carcinoma is a rare neoplasm of the upper respiratory tract which occurs in adults, most commonly in the larynx. In the literature only one case of spindle cell carcinoma, located in the maxilla, has been reported in a child. We report the first presentation of a spindle cell carcinoma in a child, which was located in the parotid gland, together with the clinical course. The diagnostic challenge associated with this unusual disorder is elucidated, as well as the role of immunohistochemical and cytogenetic examination to define the nature of these lesions.
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Affiliation(s)
- Jan W Brunings
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital of Maastricht, Maastricht, The Netherlands.
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Balakrishnan K, Castling B, McMahon J, Imrie J, Feeley KM, Parker AJ, Bull PD, Johnston A. Fine needle aspiration cytology in the management of a parotid mass: a two centre retrospective study. Surgeon 2005; 3:67-72. [PMID: 15861939 DOI: 10.1016/s1479-666x(05)80064-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES There is a diversity of opinion regarding the role of fine needle aspiration cytology (FNAC) in the pre-operative evaluation of the parotid mass. This study further investigates the role of FNAC from the standpoint of the clinician attempting to resolve one or more clinical issues. METHODS A retrospective study conducted at two UK Hospitals with no overlap of cytopathologists or surgeons. Patients undergoing parotidectomy at each institution were identified from Pathology department databases. The definitive histopathological diagnosis was compared with any pre-operative FNAC diagnosis. Cytology results were classified as suggestive, non-diagnostic, sampling error, or misleading. SETTING The study was conducted in a District General Hospital and a University Teaching Hospital providing secondary care for each community. RESULTS For the University Teaching Hospital the sensitivity in distinguishing malignant from benign disease was 79% (95% CI 61-97%) with a specificity 84% (95% CI 73-95%). However, three of eight patients with a primary parotid salivary gland malignancy were reported as having benign disease on FNAC. For the participating District General Hospital the sensitivity in distinguishing malignant from benign disease was 38% (95% CI 13-63%) and specificity 95% (95% CI 73-95%). CONCLUSIONS Fine needle aspiration cytology does not reliably distinguish a benign from a malignant primary salivary gland neoplasm in the participating institutions. Where clinical teams use FNAC in an attempt to resolve this clinical problem, the results should be interpreted with caution and an ongoing audit of performance is required.
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Seethala RR, LiVolsi VA, Baloch ZW. Relative accuracy of fine-needle aspiration and frozen section in the diagnosis of lesions of the parotid gland. Head Neck 2005; 27:217-23. [PMID: 15672359 DOI: 10.1002/hed.20142] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Both fine-needle aspiration (FNA) and frozen section (FS), although useful in preoperative and intraoperative management, have their advantages and pitfalls when used in the diagnosis of salivary gland lesions. The accuracy of each of these modalities has been assessed separately in many studies; a direct comparison of these techniques on a large cohort has not been well studied. Herein, we determine the relative accuracies of both FNA and FS in the diagnosis of salivary gland lesions. METHODS We reviewed a cohort of 220 cases of parotid gland FNA with histologic follow-up; FS was performed in 57 cases (26%). The sensitivity, specificity, and accuracy of FNA and FS were determined with respect to the final histologic diagnosis. For these calculations, benign diagnosis was considered negative, whereas a malignant diagnosis was considered positive. In addition, we re-reviewed the FNA and FS slides in cases that had conflicting FNA and FS results. RESULTS Of the 220 cases examined, the FNA diagnoses were as follows: benign (n = 142), malignant (n = 52), indeterminate (n = 14), and nondiagnostic (n = 12). Correlating these findings with the histologic findings, nine cases (4%) were false negative, whereas 12 (5%) were false positive. The sensitivity, specificity, and accuracy for FNA when diagnostic were 86%, 92%, and 90%, respectively. In 57 cases with FS, seven (12%) were false negative, whereas none were false positive. The FS was able to change to benign four diagnoses that were malignant by FNA and provide a diagnosis for five nondiagnostic FNAs. The sensitivity, specificity, and accuracy for FS were 77%, 100%, and 88%, respectively. The sensitivity, specificity, and accuracy for FNA and FS combined were 90%, 100%, and 95%, respectively. CONCLUSIONS Both FNA and FS provide a similar accuracy. FS may be useful if FNA is nondiagnostic and may also be useful in confirming or refuting malignancy in some cases. Hence, both techniques are complementary to each other in the diagnosis of salivary gland lesions.
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Affiliation(s)
- Raja R Seethala
- Department of Pathology & Laboratory Medicine, 6 Founders Pavilion, 3400 Spruce Street, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA
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