Role Of Fine-needle Aspiration Biopsy Research Articles

The role of fine-needle aspiration biopsy in the diagnosis of malignant tumors.

Cytopathology and histopathology play a key role in the process of diagnosing oncological diseases and premalignant conditions. Fine-needle aspiration (FNA) is one of the techniques used for obtaining biopsy of a wide variety of body tissues, causing patients minimal discomfort. Therefore, it is often considered to be the best strategy for investigating and diagnosing some precancerous or potential malignant lesions. Being successful as a means of confirming the clinical suspicion of metastatic recurrence in the cases of an already known cancer, the interest has further focused on the preliminary diagnosis of various types of benign or malignant tumors. In cases of inoperable tumors, this technique is useful for formulating the final diagnosis. FNA biopsy proved its effectiveness as a highly accurate, cost-effective, and safe technique, with potential high diagnostic yield. Immunohistochemistry, used as an additional tool to classical histopathological examination, remains a very practical and reliable technique that promises good results especially in determining the site of origin within metastatic disease.

The role of fine-needle aspiration biopsy and post-operative histology in the evaluation of thyroid nodules

Thyroid nodules present a serious problem, and mostly they do not carry neoplastic characteristics. Thus, they do not need to be surgically treated. The risk of malignancy varies from 5 to 15 %. Steps to diagnose malignancy should include a careful clinical evaluation, laboratory tests, a thyroid ultrasound exam and a fine-needle aspiration biopsy. Fine-needle aspiration biopsy (FNAB) is the most important diagnostic tool in the assessment of thyroid nodules. Today it is considered the gold standard for malignancy diagnosis in thyroid cancer. In this review we evaluate the role of FNAB and post-operative cytology in the evaluation of thyroid nodules. FNA results are classified as diagnostic (satisfactory) or nondiagnostic (unsatisfactory). Unsatisfactory smears (5–10 %) result from hypocellular specimens usually caused by cystic fluid, bloody smears, or suboptimal preparation. Diagnostic smears are conventionally subclassified into benign, indeterminate, or malignant categories. Benign cytology (60–70 %) is negative for malignancy, and includes cysts, colloid nodule, or Hashimoto thyroiditis. Malignant cytology (5 %) is almost always positive for malignancy, and includes primary thyroid tumors or nonthyroid metastatic cancers. Indeterminate or suspicious specimens (10–20 %) include atypical changes, Hurthle cells or follicular neoplasms. The new Bethesda Cytologic Classification has a 6-category classification, subdividing indeterminate further by risk factors. Considering the increasing worldwide incidence of thyroid microadenomas, recently it is recommended to undergo FNAB under ultrasound guidance even in small (< 1cm) nodules if they are correlated with suspicious ultrasonographic features or suspicious neck lymph nodes. FNAB is a cheap and reliable diagnostic tool that can be used in the selection candidates for surgery and pre-operative diagnosis of thyroid carcinomas. It was concluded that FNAB is the gold standard in the evaluation of thyroid nodules and can prevent many unnecessary surgeries. False-negative FNA cytology remains a concern for clinicians treating patients with thyroid nodules. Post-operative histology give the definitive diagnosis and studies confirm that it has a significant discordance between pre-operative cytology and post-operative histology in patients with thyroid nodule. Cytopathologists should strengthen their criteria for the identification of adenomatous hyperplasia, thyroiditis, cystic lesions or suspicious thyroid nodules to avoid misdiagnoses.

The role of fine-needle aspiration biopsy (FNAB) in the diagnostic management of parotid gland masses with emphasis on potential pitfalls.

The treatment strategy of parotid gland tumours depends mainly on the histopathological type of the lesion. Fine-needle aspiration biopsy (FNAB) is recommended in preoperative diagnostics. The aim of the study was to evaluate the FNAB standing in the diagnostic algorithm of parotid gland lesions and to correlate FNAB results in relation to the definitive histopathological diagnosis. The retrospective analyses of 651 examined and consequently surgically treated parotid gland lesions at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague between 2006 and 2016 were used. Preoperative cytological results were consequently evaluated in relation to the definitive histopathological diagnosis. The cohort consisted of 367 women and 284 men (average age 58years). FNAB was diagnostic in 604 (92.8%) patients and non-diagnostic in 47 (7.2%) patients. The result of FNAB was positive (suspicious for malignant tumour) in 89 (14.7%) patients and negative (benign) in 515 (85.3%) patients. Sensitivity of the examination was 80.00%, specificity was 93.82%, PPV 62.92%, NPV 97.28%, and LR + and LR- were 12.95 and 0.21, respectively, with an accuracy of 92.22%. Our results confirm the significant role of FNAB in the diagnostic algorithm of parotid gland lesions.

The role of fine-needle aspiration biopsy (FNAB) in Warthin tumour diagnosis and management.

Warthin tumour (WT) is the second most common benign tumour of the parotid gland. The aim of this study was to assess the value of the FNAB in the diagnosis and treatment decision in patients with WT. We performed a retrospective study of patients treated for parotid gland mass between 2006 and 2016. Patients who underwent the surgery with preoperative FNAB were considered. The first group was comprised of patients with preoperative FNAB showing WT and the second group was formed by patients with definitive histology of WT. 216 patients had FNAB with the result of WT and underwent surgery (98 women-45.4% and 118 men-54.6%). The definitive histology corresponded with the preoperative diagnosis in 201 cases (93.1%). The other way round, 222 patients were operated with definitive histology showing WT and we correlated this finding with preoperative FNAB. The result of FNAB corresponded with definitive histology of WT in 201 cases (90.5%). Counted sensitivity and specificity of the ultrasound-guided FNAB for the diagnosis of WT were, respectively: 96.63% (CI 93.19-98.64%) and 96.21 (CI 93.83-97.86%). The accuracy of this method was 96.36% (CI 94.54-97.70%). Ultrasound-guided FNAB is a safe, accurate and important method in WT diagnosis. The therapeutic approach can be chosen based on FNAB results correlated with other clinical findings. We propose that when WT is suspected, follow-up or enucleation of the tumour are appropriate treatments. Patient preferences should be also considered.

Does fine-needle aspiration biopsy still have a place in the diagnosis of breast lesions?

IntroductionCore needle biopsy is a preferable breast biopsy technique under ultrasound guidance. However, fine-needle biopsy is considered equally popular.Aim of the studyTo redefine the role of fine-needle aspiration biopsy (FNAB) in the diagnosis of breast lesions.Material and methodsWe retrospectively analysed the medical records of 680 patients who underwent breast ultrasound examination. In most cases, no pathologic structures were observed within the mammary glands. In 321 patients, the presence of focal lesions was revealed, and 107 patients in this group qualified for FNAB according to current recommendations. Patients with suspicious smears were referred for core needle or surgical biopsy. Patients with benign cytological smears underwent repeated ultrasound checks at 6-month intervals during the following year.ResultsAll the smears were diagnostic. The vast majority of the results were categorised as benign lesions. Cancer cells were detected in six women. In one patient the lesion was classified as suspicious, probably malignant. In all of these cases, open biopsy was performed, and histopathological examination confirmed the presence of a malignant tumour. The patients were given appropriate oncological treatment. For women with benign or suspicious, but probably benign, lesions, breast ultrasound was performed twice at six-month intervals. Control tests showed no significant changes compared to the baseline examination. None of the patients required extensive additional diagnostic tests.ConclusionsFNAB is a reliable method of assessing pathologic lesions in mammary glands.

Fine-needle versus core-needle biopsy - which one to choose in preoperative assessment of focal lesions in the breasts? Literature review.

AimThe aim of the study was to review two techniques that can be used to verify focal lesions in the breasts: fine-needle aspiration biopsy and core-needle biopsy.Material and methodsFifty-five articles (original papers and reviews), half of them published within the past 5 years, were included in the analysis. The authors also took their own experience into account.ResultsPre-operative assessment of focal lesions in the breasts is crucial in the planning of further therapeutic management. The role of fine-needle aspiration biopsy has been reduced lately due to its low sensitivity and specificity as well as a high rate of non-diagnostic, suspicious and false negative results. This method does not enable one to differentiate between in situ and invasive disease. Currently, fine-needle biopsy is recommended for cystic lesions, suspected of being recurrences in the chest wall, and lymph node metastases. Core-needle biopsy is the basic diagnostic method of breast lesions. According to the recommendations of the Polish Ultrasound Society and American College of Radiology, BIRADS 4 and 5 lesions should be evaluated histopathologically. Core-needle biopsy makes it possible to establish a final diagnosis more frequently than fine-needle biopsy, both in the case of benign and malignant lesions. It delivers more information about the nature of a tumor (mutation of HER-2, estrogen and progesterone receptors and Ki-67 index). Its limitations include: underestimation of invasion and failure to recognize the components of ductal carcinoma in situ in papillary and atypical lesions. Single fine-needle aspiration biopsy is inexpensive, but when considering the cost of further diagnosis due to non-diagnostic, suspicious and atypical results, this method generates high additional costs.ConclusionsMicroscopic verification of focal breast lesions is crucial for further therapeutic decisions. It has been proven that histopathological verification is more accurate and has more advantages than cytological assessment.

Cytomorphological spectrum of epididymal nodules: An institution's experience.

Background:Epididymal lesions are uncommon in clinical practice. Few case series has been described in the literature documenting the role of cytology in the evaluation of epididymal nodules. This study was undertaken to analyze the cytomorphology of epididymal nodules and to evaluate role of fine-needle aspiration biopsy (FNAB) in early definitive diagnosis of epididymal nodules.Materials and Methods:A total of seventy cases of epididymal nodules were aspirated over a period of 6 years in the Department of Pathology. These cases were taken from the cytology record as a part of this study. The aspiration was performed using 22/23-gauge needle. Smears were stained with May-Grunwald-Giemsa and Papanicolaou stains. Special stains and immunocytochemistry were performed, wherever required.Results:The cytological features were adequate to establish the diagnosis in sixty cases. The lesions diagnosed were tuberculosis 16 (22.85%), spermatoceles 12 (17.14%), benign cystic lesion 8 (11.42%), encysted hydrocele 8 (11.42%), acute suppurative lesion 6 (8.57%), filariasis 4 (5.71%), chronic epididymitis 3 (4.28%), nodular fasciitis 1 (1.42%), epidermal inclusion cyst 1 (1.42%), and cystic adenomatoid tumor 1 (1.42%). Ten cases were inadequate to establish the diagnosis. FNAB was useful in diagnosis of 86% of cases. Infectious lesions of the epididymis were more common than neoplastic lesions. Patients with infection responded well to medical treatment.Conclusions:FNAB is an easily available technique for palpable lesions of epididymis, and it helps in making an early, near definitive diagnosis of epididymal lesions. It also helps to avoid unnecessary surgical interventions and helps in timely management.

Usefulness of thyroglobulin in cervical lymph node fine-needle aspirations at initial thyroidectomy for the diagnosis of metastases in papillary thyroid cancer

To study the role of fine-needle aspiration biopsy and thyroglobulin measurement (FNAB-Tg) in diagnosing cervical lymph node (CLN) metastases in patients with papillary thyroid cancer (PTC) before thyroidectomy. Ultrasonography (US)-guided FNAB was performed on 92 patients with PTCs with 105 CLNs before surgery. The wash-out of the FNAB-Tg level was detected. Based on the final pathology, 67 lymph nodes (LNs) were positive for metastasis, and 38 LNs were negative for metastasis. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of FNAB-Tg in thyroidectomized patients was 100%, 86.8%, 95.2%, 97.3%, and 95.2%, respectively. FNAB-Tg is a useful technique for diagnosing CLN metastasis of PTC before thyroidectomy. .

Role of Fine-Needle Aspiration Biopsy in the Management of Salivary Gland Masses

Fine-needle aspiration biopsy (FNAB) is widely used in the management of salivary gland masses. Its main advantage is its ability to differentiate benign from malignant disease. In this study, we aimed to evaluate the diagnostic ability of FNAB in salivary gland masses. The records of patients who had undergone FNAB before parotidectomy or submandibular gland excision between 2005 and 2013 were retrospectively analyzed. FNAB results were classified as negative, positive, suspicious for malignancy, and non-diagnostic. Preoperative FNAB results were compared with definitive histopathological results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of FNAB results were calculated. A total of 285 patients were enrolled. Among them, 230 (80.7%) had parotid gland and 55 (19.3%) had submandibular gland masses. Following a definitive histopathological examination, the most common benign tumor was pleomorphic adenoma (52.6%), whereas malignant tumors were mucoepidermoid carcinoma (2%) and squamous cell carcinoma (2%). The sensitivity, specificity, PPV, NPV and accuracy of FNAB results were 76.9%, 95.4%, 75%, 95.9%, and 92.6%, respectively. The rate of a suspicious cytology was 5.2% (15 patients) and that of a non-diagnostic cytology was 8.8% (25 patients). FNAB is a safe and simple diagnostic tool for the diagnosis of salivary gland masses and has a relatively high sensitivity and specificity. It may provide valuable information for patient counselling and surgical planning. The major drawbacks include a lower sensitivity than specificity and a relatively high rate of non-diagnostic results.

The role of fine-needle aspiration biopsy in the dynamic monitoring of patients with nodular goiter

Review of the literature devoted to the relevance of fine-needle aspiration biopsy in the diagnosis of thyroid nodules. Application of the new classification system, the interpretation of FNA can significantly increase the reproducibility of the method and reduce the number of false-negative results. This review summarizes recent data on the epidemiology of thyroid nodules, new system of the interpretation of FNA cytology findings, the role of FNA in the dynamic monitoring of benign tumors of thyroid gland.

Thyroid nodules in children and adolescents: a single institution’s experience

The aims of this study were to analyze the role of fine-needle aspiration biopsy (FNAB) in the management of pediatric thyroid nodules and to analyze the malignancy risk of thyroid nodules by studying the association between autoimmune thyroiditis and thyroid cancer. We conducted a retrospective study on 111 patients with thyroid nodules diagnosed in childhood or adolescence. FNAB was performed in 46 participants with thyroid nodules after ultrasonography (US). Cytology diagnoses were categorized as insufficient, benign, suspicious, and malignant. Clinical and surgical follow-up data were obtained from medical records. The clinical correlation and accuracy of FNABs were evaluated. The family history was positive in four patients. Forty-six patients had positive antithyroid antibodies and an inhomogeneous hypoechogenic US pattern. One patient had previous neck irradiation history. Eighty-six patients (%77.5) were euthyroid. All patients underwent US examination. The FNAB results of the 46 patients were 29 (63%) benign cases, 7 (15%) insufficient, and 10 (22%) suspicious patients. Malignancy was not reported at all. A repetition of FNAB in two benign cases, which were diagnosed with papillary carcinoma during followup, reported these cases as suspicious. Ten patients with suspicious FNAB results underwent surgery because of increases in the size of the nodules; two patients were diagnosed with papillary carcinoma. In this study, the prevalence of malignancy was 4.5% in patients with thyroid nodules. In this study, the importance of FNAB in the diagnosis and follow-up of thyroid nodules in childhood has been observed, and risk factors, such as history of familial thyroid carcinoma, radiotherapy to the neck at younger ages, suspicious cytological findings, and increased nodular sizes during follow-up in cases with Hashimoto thyroiditis have been correlated with increased thyroid carcinoma malignancy risk.

The Head and Neck Surgeon as Clinician-Investigator<subtitle>Opportunities and Imperatives: The Hayes Martin Lecture</subtitle>

I am honored to have been asked to present this memorial lecture in memory of Hayes Martin, MD, who is considered the father of contemporary head and neck surgery. Dr Martin was born in 1892 and died in 1977. As the chief of the head and neck surgery service at Memorial Sloan-Kettering Cancer Center, New York, New York, Dr Martin made many outstanding observations and contributions that were fundamental to the surgical management of head and neck cancer. These include the role of fine-needle aspiration biopsy for the diagnosis of solid tumors of the head and neck, management of the unknown primary, and the appropriate surgery for cervical metastasis. Dr Martin’s concepts were empirical and based on his keen observational skills and experience. He was indeed a clinician-investigator.

Fine-needle aspiration biopsy in the diagnosis and follow-up of thyroid nodules in childhood

Objective: To assess the role of fine−needle aspiration biopsy (FNAB) in the management of pediatric thyroid nodules.Methods: Results of 30 FNABs performed in our clinic were retrospectively reviewed. Clinical and surgical follow−up data were obtained from the patient files, and clinical correlation and accuracy of FNAB were evaluated.Results: The results of 30 FNABs were reported as benign in 24 (80%), insufficient in 4 (13.3%) patients, malignant in 1 (3.3%), and suspicious in 1 (3.3%) patient. One patient with a FNAB result of malignancy underwent surgery and the histological diagnosis was papillary carcinoma. FNAB was repeated in two of the insufficient biopsies, and reported as benign; in one of these patients, the thyroid nodule disappeared and in one, remained stable at clinical follow−up. Four of the patients with benign FNAB results underwent surgery at clinical follow−up because of an increase in the size of the nodules and one patient was found to have papillary carcinoma. The remaining patients were clinically followed. In this study, the malignancy prevalence was 6.6% in patients with thyroid nodules. There was only one falsenegativecase.Conclusion: FNAB is a reliable diagnostic tool in the management of pediatric thyroid nodules.Conflict of interest:None declared.

Role of fine-needle aspiration biopsy in the diagnosis of metastatic desmoplastic melanoma to the parotid and submandibular region

Melanomas are malignant tumors prone to develop in regional and distant metastatic foci. Desmoplastic melanoma is an uncommon melanoma variant that commonly affects the head and neck and can promote early regional metastasis through both lymphatic and neural routes. We report an uncommon case of metastatic desmoplastic melanoma from the scalp to submandibular and parotid lymph nodes in a 79-year-old male, diagnosed through fine-needle aspiration biopsy. This report reinforces the importance of considering melanoma metastasis on the differential diagnosis of asymptomatic salivary gland swellings and the utility of fine needle aspiration biopsy in their early diagnosis.

The role of fine needle aspiration biopsy in the diagnosis of melanoma

The role of fine needle aspiration biopsy (FNAB) is discussed in the follow up of patients with the diagnosis of malignant melanoma. The review is based on literary data and the author's own material. The primary role of FNAB is to confirm metastatic or recurrent melanoma lesions. US or CT guided FNAB is valuable in the diagnosis of visceral metastases. FNAB has limited role in the diagnosis of primary melanomas except in cases with unusual clinical presentation (e.g. oral mucosa). In spite of the well-known cytology the diagnosis can be difficult due to the inherent histological variation of malignant melanomas, especially in cases with unusual localisation and amelanotic tumor presentation when immunocytochemistry is needed. The known clinical history of melanoma is very helpful.

Fine-needle aspiration biopsy cytology of malignant neoplasms of the sinonasal tract.

Primary and metastatic malignancies that originate in the sinonasal tract are rare and histologically diverse. The role of fine-needle aspiration biopsy (FNAB) and the cytomorphologic features of these tumors have not been specifically addressed. The authors reviewed 22 cytology cases (20 FNABs, 1 sputum sample, and 1 pleural fluid sample) from 18 patients with malignancies originating in the sinonasal tract (17 carcinomas, 3 melanomas, and 2 sarcomas) and assessed the cytomorphology, cytohistologic correlation, and ability of cytology to render a specific diagnosis. Primary and metastastic sites sampled by FNAB included masses in or around the nose (n = 2), orbit (2), maxillary sinus (2), frontal sinus (1), intraoral area (1), preauricular area (1), soft tissue neck masses, parotid and lymph nodes (10), and cervical spine (1). Exfoliative cytology was positive in two samples of sputum and pleural fluid, representing the initial cancer diagnosis before the sinonasal primary tumor was detected. Seventeen of 22 (77.3%) cases were classified as carcinoma not otherwise specified, carcinoma with specific differentiation, sarcoma, or melanoma. Cytology failed to correctly classify the specific subtype of three carcinomas. The cytologic features that were evaluated included cellularity, cellular arrangement, nuclear features, nuclear-to-cytoplasmic ratio, and the background appearance. Sinonasal tract malignancies demonstrate a wide range of cytologic findings but specific features allowing for an accurate and definitive diagnosis are often present in many tumors. Fine-needle aspiration cytology is an important diagnostic tool in the management of sinonasal malignancies and can be complemented by the use of ancillary studies for the diagnosis of poorly differentiated or nonepithelial tumors.

Role of fine-needle aspiration biopsy and frozen-section evaluation in the surgical management of thyroid nodules.

The role of routine frozen section (FS) in the surgical management of thyroid nodules remains uncertain. This study reviewed the role of FS in the presence of an adequate fine-needle aspiration biopsy (FNAB). FNAB and FS were evaluated in 206 patients who had surgery for a thyroid nodule. Cytological specimens were classified as benign, malignant or suspicious. The FS diagnoses were benign, malignant or deferred. A cytological diagnosis was obtained in 93 nodules; the remaining 113 were classified as suspicious, of which 21 were malignant on definitive examination. The overall accuracy of FNAB was 53 per cent. FS evaluation identified 165 lesions as benign; the diagnosis was deferred until definitive histological evaluation in only eight. The overall accuracy, therefore, was 96 per cent. Routine use of FS was cost-effective; lowering the number of reoperations led to an estimated saving of about 40 per cent. These data suggest that FS remains an important tool in the surgical management of thyroid nodules and can reduce the number of patients requiring reoperation.

The Role of Fine-Needle Aspiration Biopsy in the Evaluation of Head and Neck Masses

Purpose: The purpose of this study is to evaluate the role of diagnostic fine-needle aspiration biopsy (FNAB) of head and neck masses and to calculate the sensitivity and specificity of this method. Materials and Methods: The records of 219 patients who had undergone an FNAB of head or neck masses were reviewed. FNAB results were correlated with the histopathologic findings observed after surgery in 96 of 219 patients. Sensitivity, specificity and positive predictive value of FNAB for the detection of malignancy were calculated. Results: Four false-negative, 4 false-positive and 22 unsatisfactory results were obtained using FNAB, according to histopathologic findings. The overall sensitivity, specificity, accuracy and positive predictive value for malignancy were 87.5, 93.8, 91 and 87.5%, respectively. Conclusions: FNAB is a useful diagnostic tool for head and neck masses. However, FNAB results by themselves could be insufficient in the management of head and neck masses; therefore, they should be combined with clinical and radiologic findings.

The role of fine-needle aspiration biopsy in the diagnosis and management of juvenile hemangioma of the parotid gland and cheek.

The current recommendation for the management of juvenile hemangiomas (JH) is to delay treatment in the hope of spontaneous regression. However, accurate diagnosis is necessary before considering conservative management. Traditionally, the diagnosis of JH has required excisional biopsy. The cytology literature on this relatively rare neoplasm is sparse. To present our experience with fine-needle aspiration in the diagnosis and management of JH. Three cases with a cytologic diagnosis consistent with JH of the parotid gland and cheek were identified from our cytopathology files. Aspirate smears, immunohistochemical studies, computed tomographic scan findings, and clinical follow-up were reviewed. Patients were female infants ranging in age from 3 to 9 months and presented with an oval firm mass (size range, 2.0-5.0 cm) involving the parotid gland (2 cases) and cheek (1 case). Computed tomographic scan with contrast demonstrated homogeneous enhancement. Aspirate smears revealed spindle-shaped cells in sheets and clusters in a background of blood. The parotid gland aspirates and cell block preparations revealed ductal structures entrapped in sheets of spindle-shaped cells. Immunohistochemical studies revealed prominent vascular spaces lined by CD34 and factor VIII-positive flattened endothelial cells. The diagnosis of JH was rendered on the basis of the cytologic findings in conjunction with the radiologic and clinical findings. On clinical follow-up (8-24 months), none of the patients has shown any progression of the lesion. Fine-needle aspiration, in conjunction with imaging studies, is a useful tool in the diagnosis and management of JH. It eliminates the need for surgical excision for diagnostic purposes and allows for clinical follow-up of patients with JH.

The role of fine-needle aspiration biopsy in the diagnosis and management of juvenile hemangioma of the parotid gland and cheek.

Abstract Background.—The current recommendation for the management of juvenile hemangiomas (JH) is to delay treatment in the hope of spontaneous regression. However, accurate diagnosis is necessary before considering conservative management. Traditionally, the diagnosis of JH has required excisional biopsy. The cytology literature on this relatively rare neoplasm is sparse. Objective.—To present our experience with fine-needle aspiration in the diagnosis and management of JH. Design.—Three cases with a cytologic diagnosis consistent with JH of the parotid gland and cheek were identified from our cytopathology files. Aspirate smears, immunohistochemical studies, computed tomographic scan findings, and clinical follow-up were reviewed. Results.—Patients were female infants ranging in age from 3 to 9 months and presented with an oval firm mass (size range, 2.0–5.0 cm) involving the parotid gland (2 cases) and cheek (1 case). Computed tomographic scan with contrast demonstrated homogeneous enhancement. Aspira...