Salivary Gland Cysts Research Articles

Imaging of sialadenitis.

Sialadenitis is an inflammation or infection of the salivary glands that may affect the parotid, submandibular and small salivary glands. Imaging findings vary among unilateral or bilateral salivary gland enlargement, atrophy, abscess, ductal dilation, cysts, stones and calcification. Imaging can detect abscess in acute bacterial suppurative sialadenitis, ductal changes with cysts in chronic adult and juvenile recurrent parotitis. Imaging is sensitive for detection of salivary stones and stricture in obstructive sialadenitis. Immunoglobulin G4-sialadenitis appears as bilateral submandibular gland enlargement. Imaging is helpful in staging and surveillance of patients with Sjögren's syndrome. Correlation of imaging findings with clinical presentation can aid diagnosis of granulomatous sialadenitis. Post-treatment sialadenitis can occur after radiotherapy, radioactive iodine or surgery.

Ectopic salivary gland cyst in the neck: Association with congenital plunging ranula

Congenital ranula is rare. We report a large, symptomatic, congenital plunging ranula associated with a salivary gland cyst in the neck. To the best of our knowledge, this is the first such reported case. Even though both the cysts had their origin from the sublingual gland, only the cervical cyst had a capsular covering. Herniation of a part of the immature sublingual gland anlage through a congenital mylohyoid defect, its separation, and subsequent maturation could explain this occurrence.

Plunging Ranula mimicking Extensive Submandibular Gland Abscess: A Diagnostic Challenge

ABSTRACTRanula is a salivary gland cyst that typically presents as localized superficial swelling over the floor of the mouth. Complex or plunging ranulas develop when the mucus extravasation extends through or around the mylohyoid muscle, deeper into the neck, and present with neck lump along with or without swelling over the floor of mouth. It is not a straightforward diagnosis in case of superimposed infection as it will resemble a submandibular gland abscess clinically and radiologically. We report here a case of large plunging ranula, which initially diagnosed radiologically as submandibular gland abscess with extension to parapharyngeal space.How to cite this articleAmiruddin S, Razali MS, Esa KB. Plunging Ranula mimicking Extensive Submandibular Gland Abscess: A Diagnostic Challenge. Int J Otorhinolaryngol Clin 2016;8(3):119-121.

Cytomorphological findings and histological correlation of papillary cystadenocarcinoma of the parotid: Not always a low-grade tumor

Papillary cystadenocarcinoma (PCAC) is a rare salivary gland tumor characterized by a predominantly cystic growth that often exhibits intraluminal papillary growth without specific histologic features of other cystic salivary gland tumors. The preoperative cytological diagnosis can pose a diagnostic challenge as it has to be differentiated from other cystic papillary tumors such as mucoepidermoid carcinoma, papillary cystic variant of acinic cell carcinoma, and low-grade cribriform CAC. It is considered to be a low-grade malignant salivary gland tumor with an indolent biological behavior. We report a case of PCAC of the parotid in a 55-year-old male diagnosed on fine needle aspiration cytology. Although it showed mild atypia cytologically, on excision tumor showed vascular and perineural invasion with regional node metastasis indicating a wider morphologic spectrum than what is described. This prompted us to write a case report describing the cytological and histological features of this rare tumor and also discuss the diagnostic challenges.

Amylase crystalloids in fine needle aspiration cytology of parotid gland: A diagnostic challenge

Sir, Several types of crystalloids may be seen in fine needle aspiration cytology of benign or malignant lesions of the salivary gland.[1,2] Due to their rarity, they may lead to confusion in diagnosis. Amylase type crystalloids (sometimes named nontyrosine crystals) are rarely found angular, nonbirefringent rectangular formed structures, with geometric shapes ranging between 5 μ and 500 μ in size and stained orange with Papanicolaou (PAP), dark blue with Diff-Quik® (DQ) and pink with Hematoxylin-Eosin (HE) stain. They were first defined in salivary gland cysts in 1983 by Takeda and Ishikawa.[1,3] Amylase crystalloids may also be observed in cystic sialadenitis as much as in cystic lesions.[1] We have presented here a case with cystic and chronic sialadenitis in the parotid gland, containing amylase crystalloids. The ultrasonographic assessment performed on a 58-year-old female patient who had applied with a complaint of swelling in the frontal part of the left ear and on the left part of the neck resulted in the detection of a lesion at a size of 12.5 mm × 11 mm in the lower zone of the left parotid [Figure 1] and lymph node at a diameter of 1 cm in the left cervical area. Figure 1 Ultrasonographic picture of the parotid mass Ultrasound-guided fine needle aspiration was performed by cytopathologist (N.P) with the preliminary diagnosis of the parotid tumor. About 0.2 cc of a mucoid fluid at an off-white color was aspirated. The slides were stained with DQ, PAP and HE. Cytologic findings showed mixed-type inflammatory elements, proliferated salivary gland acinar cells, reactive atypical salivary gland ductal cells as well as square, cuboid, needle, rectangular, rhomboid or bar-shaped crystalloids [Figure ​[Figure2a2a–d]. The crystalloids were stained bright orange with PAP; deep blue with DQ and eosinophilic with HE [Figure ​[Figure3a3a and ​andb].b]. Birefringence of the crystalloids was not observed by polarized light. The case was reported as cystic and chronic sialadenitis containing amylase crystalloids. The patient was monitored, and no growth was detected in the 2 years follow-up. Figure 2 Various cytologic images of the amylase crystalloids on different power and stains. (a) Diff-Quik®, ×100. (b) Diff-Quik®, ×200. (c) Papanicolaou, ×200. (d) H and E, ×400 Figure 3 Images of crystalloids at high power magnification with representative morphology. (a) Diff-Quik®, ×400. (b) H and E, ×400 Many crystals such as amylase, tyrosine, collagenous crystalloids, oxalate and intraluminal crystals may be observed in the fine needle aspiration smears of salivary gland lesions.[1,2,4] It is important to differentiate amylase crystalloids, which are geometric-shaped structures larger than 5 μm microscopically, from other crystalloids. Because, although crystalloids may be seen in malignant salivary gland tumors, amylase crystalloids accompany benign lesions.[1,5] The different types of crystals/crystalloids in relation to benign and malignant lesions and special stains/methods of detection are outlined below. Intraluminal crystalloids show a structure with geometrical shapes like amylase crystalloids. However, intraluminal crystalloids are dense, amorphous, filled with eosinophilic substance and at a size of 100 μ. Intraluminal crystalloid are reported to be seen in malignant salivary gland tumors.[6] Amylase crystalloids have more translucent appearance and are generally at a size of 500 μ. They are stained orange with PAP, dark blue with DQ® and pink with HE. Both intraluminal and amylase crstalloids are nonbirefringent. Amylase crystalloids are so far encountered with only in benign lesions including chronic sialadenitis, unilocular cysts, lymphoepithelial cysts and Warthin's tumor.[1,7] Collagenous crystalloids are seen as radial and fusiform fibers of eosinophilic collagen on HE stain. These crystalloids stain bright blue on trichrome stain, indicating the presence of Type I collagen and are also positive on Snook Reticulin Stain, indicating the presence of Type III collagen. They are birefringent. Collagenous crystalloids are reported to be seen in pleomorphic adenomas, myoepitheliomas and also myoepithelial carcinomas.[5,6] Tyrosine crystals appear in an eosinophilic, refractile, flower-like shape with blunt ends (petal shaped) on HE stain. Tyrosine crystalloids are reactive with Millon reagent and are positive with diazotization-coupling reaction. They are nonbirefringent. Tyrosine crystals are mainly identified in pleomorphic adenomas and also rarely encountered in malignant salivary gland neoplasms such as carcinoma ex pleomorphic adenoma, adenoid cystic carcinoma, low-grade adenocarcinoma.[1,2,5,6] In conclusion, amylase crystalloids are not substances that may appear very frequently in parotid fine needle aspiration. They may accompany especially nonmalignant benign, chronic inflammatory lesions. They are rarely observed. We wanted to present our case in the light of literature for the purpose of highlighting the fact that crystalloids may lead to diagnostic challenges in parotid fine needle aspiration. We also focused on the representative cytomorphology of the crystalloids.

A pediatric case of mammary analogue secretory carcinoma within the parotid

Mammary analogue secretory carcinoma (MASC) is a recently described entity in the differential diagnosis of salivary gland tumors. It is notable for a characteristic t(12;15)(p13;q25) translocation that results in a unique fusion protein, ETV6-NTRK3. While several studies have retrospectively identified this translocation in cases previously diagnosed as a different salivary malignancy, there have been relatively few cases where this translocation was identified on initial pathology results, and fewer still in a pediatric population. We present a case of a 15 year old female with a slowly enlarging, painless, left facial mass. MRI demonstrated a cystic mass extending into the deep lobe of the parotid, and she underwent parotidectomy. The tumor cells stained positive for S100 and CK19. ETV6 translocation was present, confirming the diagnosis. Mammary analogue secretory carcinoma is a recently described tumor of the salivary glands, which often masquerades as more common primary salivary gland tumors and cysts. More research is needed to characterize the typical behavior of this neoplasm and the optimal treatment regimen. With identification of its characteristic translocation, mammary analogue secretory carcinoma can be easily differentiated from its more prevalent counterparts, and should therefore remain within the differential of the pathologist and head and neck surgeon.

Numb chin syndrome: a case series of a clinical syndrome associated with malignancy.

Information regarding the appropriate work-up and outcomes in patients receiving palliative treatment for numb chin syndrome (NCS) in the setting of malignancy is sparse. This study aims to describe NCS in malignancy and evaluate the disease trajectory, significance of diagnostic modalities and outcomes with palliative treatment. A retrospective study was performed on patients presenting with NCS between March 2007 and October 2013 at the Capital Region Cancer Service, Canberra. Thirteen patients were identified who presented with numbness of the chin between March 2007 and October 2013. Seven patients had breast cancer, two had prostate cancer, two had multiple myeloma, one had medulloblastoma and one had an adenoid cystic salivary gland tumour. The mean interval from initial cancer diagnosis to development of the syndrome was 4.32 years. Twelve out of 13 patients had had prior chemotherapy with two or more lines of treatment (with a median of two lines), indicating this condition tended to present late in the course of disease in our patients. Four patients developed bilateral symptoms, and in two of these cases the metastatic lesion was in the base of the skull. Eleven out of 13 patients had positive signs on imaging. Nine out of 13 patients received palliative radiotherapy, with clinical response in eight patients. Patients with malignancy presented with NCS late in the disease trajectory, often after multiple lines of treatment. In our cohort of patients, 84% had positive imaging signs to aid diagnosis, and 77% had resolution of numbness with palliative treatment.

Apocrine Hidrocystoma of the Lower Lip: A Case Report and Literature Review

The hidrocystomas (HCs) are cystic forms of sweat gland resulting from proliferation of the apocrine secretory coil or eccrine duct. Apocrine -HCs are cystic lesions that arise from the apocrine secretory coil, while eccrine -HCs represent retention cysts of the eccrine duct. The commonest site for such lesions is around the eye, and they may also occur on the ears, scalp, chest, shoulders, or feet. However, HCs of the perioral region are uncommon. The differential diagnosis with minor salivary gland cyst or cystic neoplasms often poses a problem in this site. Here we report a rare case of apocrine -HC of the right lower lip for which excisional biopsy of the lesion was performed. Histopathologically, the lesion was a unilocular cyst lined by a double-layered epithelium of the apocrine secretory type. Immunohistochemically, the secretory epithelium was positive for mammaglobin, gross cystic disease fluid protein 15 (GCDFP-15), cytokeratin 7 (CK 7) and CK18, and the myoepithelium was positive for alpha-smooth muscle actin (α-SMA) and weakly positive for S100 protein. Here we present this very rare case of apocrine -HC of the lower lip, and discussed regarding differential diagnosis with minor salivary gland cystic lesion in the lip.

Salivary Duct Cyst: Histo-pathologic Correlation

Non-neoplastic cysts of the salivary glands are uncommon and represent 2-5% of all salivary gland lesions. They are mainly mucoceles or salivary duct cysts. Unlike a mucocele, which is surrounded by granulation tissue, the salivary duct cyst is lined by epithelium. Salivary duct cysts are more common in the oral minor salivary glands and rarely occur in the major salivary glands, show a marked predilection for the superficial lobe of the parotid, and represent 10% of all salivary gland cysts. Neoplastic differentiation of the lining of the salivary duct cyst has been reported. We report a case of a salivary duct cyst of the left parotid gland, with a review of radiographic and histopathologic features.

Mammary Analogue Secretory Carcinoma Mimicking Salivary Adenoma

Mammary analogue secretory carcinoma (MASC) is a recently described salivary gland tumor characterized by ETV6 translocation. It appears that prior studies have identified MASC by reviewing salivary gland carcinomas, such as acinic cell carcinoma and adenocarcinoma, not otherwise specified. To address the possibility of MASC mimicking benign salivary neoplasms we reviewed 12 salivary gland (cyst)adenomas diagnosed prior to the discovery of MASC. One encapsulated (cyst)adenoma of the parotid gland demonstrated features of MASC. The diagnosis was confirmed by fluorescence in situ hybridization with an ETV6 break-apart probe. An unusual complex pattern of ETV6 rearrangement with duplication of the telomeric/distal ETV6 probe was identified. This case illustrates that MASC may mimic salivary (cyst)adenomas. To more accurately assess true clinical and morphologic spectrum of MASC, future studies may have to include review of salivary (cyst)adenomas. The differential diagnosis of MASC may have to be expanded to include cases resembling salivary (cyst)adenomas.

Pituitary symptomatic salivary gland rest cyst: case report.

Although salivary gland rest in posterior pituitary is frequently observed during microscopic examination at autopsy, this rest tissue rarely causes clinical symptoms. So far, only three symptomatic salivary gland rest cyst in pituitary was reported. The author reports the 4th case of symptomatic pituitary salivary gland rest cyst in 26-year-old woman presenting with severe headache. The lesion showed hyperdense shadow on computed tomography, high signal on T1-weighted image and low signal on T2-weighted image magnetic resonance imaging. There was no enhancement of the mass after gadolinium injection. Trans-sphenoidal approach revealed that the cyst wall consisted of normal appearing salivary gland and gelatinous cyst content. Although the pituitary salivary gland rest cyst is rarely symptomatic, it should be take into consideration in the differential diagnosis of pituitary lesions.

Pathological Features of Salivary Gland Cysts in a Shiba Dog with GM1 Gangliosidosis: A Possible Misdiagnosis as Malignancy

Salivary gland cysts are often concurrent with GM1 gangliosidosis in Shiba dogs. Although the etiology is unknown, these cysts may be misdiagnosed as malignant due to the accumulation of foamy cells. The present study investigated the cytological, histopathological, immunohistochemical and electron microscopic characteristics of salivary gland cysts in a Shiba dog affected with GM1 gangliosidosis. The salivary gland masses were surgically enucleated and examined clinicopathologically and pathologically in a 7-month-old Shiba dog with GM1 gangliosidosis. Many large cells with rich cytoplasm including vacuoles of various sizes, i.e., foamy cells, were observed in stamp smears from the cut-surface of the masses and histopathologically in major parts of the cyst wall. Some of these foamy cells presented features similar to a spider-web appearance. The foamy cells were confirmed to have originated from macrophages based on marked immunohistochemical expression of vimentin, HLA-DR, lysozyme and Iba1. An ultrastructural study demonstrated electron-dense vesicular structures in the vacuolated cells. Therefore, the masses were diagnosed pathologically as benign salivary gland cysts with accumulation of foamy cells. In conclusion, the histopathological features of the salivary gland cysts in this Shiba dog were similar to those of lipoma and/or liposarcoma. In such cases, immunohistochemical and ultrastructural examinations were useful in the differential diagnosis. Practitioners, clinical pathologists and pathologists should take GM1 gangliosidosis into consideration when they encounter salivary gland cysts in Shiba dogs.

Diseases of the salivary glands in infants and adolescents.

BackgroundDiseases of the salivary glands are rare in infants and children (with the exception of diseases such as parotitis epidemica and cytomegaly) and the therapeutic regimen differs from that in adults. It is therefore all the more important to gain exact and extensive insight into general and special aspects of pathological changes of the salivary glands in these age groups. Etiology and pathogenesis of these entities is still not yet fully known for the age group in question so that general rules for treatment, based on clinical experience, cannot be given, particularly in view of the small number of cases of the different diseases. Swellings of the salivary glands may be caused by acute and chronic inflammatory processes, by autoimmune diseases, by duct translocation due to sialolithiasis, and by tumors of varying dignity. Clinical examination and diagnosis has also to differentiate between salivary gland cysts and inflammation or tumors.ConclusionSalivary gland diseases are rare in childhood and adolescence. Their pattern of incidence differs very much from that of adults. Acute and chronic sialadenitis not responding to conservative treatment requires an appropriate surgical approach. The rareness of salivary gland tumors is particularly true for the malignant parotid tumors which are more frequent in juvenile patients, a fact that has to be considered in diagnosis and therapy.

Re: Acinic Cell Carcinoma of Salivary Gland with Massive Deposits of Globular Amyloid

We had a case similar to the one reported by Drut and Gimenez, which we called “Psammoma bodyrich papillary cystic acinic cell carcinoma,” and we presented this at the 34th European Congress of Cytology, June 15-18, 2008, in Rovaniemi, Finland. A 24-year-old woman presented with a 5-month history of a painless lump on the left side of the face. A preliminary diagnosis of papillary cystic salivary gland neoplasm was made on fine-needle aspiration (FNA), and a superficial parotidectomy was performed. The final diagnosis was papillary cystic acinic cell carcinoma with numerous psammoma bodies. The smears were highly cellular, mainly composed of papillary clusters and isolated cells with vacuolated cytoplasm; eccentric round nuclei and inconspicuous nucleoli, resembling foamy histiocytes; and numerous psammoma bodies with concentric lamination and radial striations (Figures 1A and 1B). Some of the psammoma bodies were surrounded by the abovementioned vacuolated cells, resembling cannon balls (Figure 2). There was also a moderate amount of colloid-like particles, some of them partially calcified. The cell block showed papillary clusters with many psammoma bodies (Figure 3). The gross specimen consisted of a portion of parotid measuring 6 × 5 × 4 cm, containing a International Journal of Surgical Pathology Volume 17 Number 3 June 2009 276-278 © 2009 The Author(s) 10.1177/1066896909332729 http://ijsp.sagepub.com Letter to the Editor

Pre‐morbid morphological conditions of the human pituitary

The clinically silent premorbid conditions of the pituitary, in particular preneoplastic features, were morphologically and statistically investigated within a control population at autopsy. A higher percentage of premorbid states were found, which was speculated to be a basis of possible later clinical lesions. They were as follows in 228 pituitary specimens: incidentalomas in 3% (potential pituitary adenomas), aberrant salivary gland cell clusters in the pars intermedia in 8.8% (potential salivary gland cysts or carcinomas in the sellar region), residual Rathke's cleft cells in 3.2-6.8% (potential craniopharyngiomas), meningothelial aggregates in the pituitary capsule in 4.0% (potential meningiomas), one case also had ciliated epithelial cell fragments in the anterior lobe, one case each of granular cell and nerve cell group in the posterior lobe, and two cases of telangiectasia. Furthermore, aberrant anterior pituitary cells were found in the leptomeniges of the peri-pituitary region as a possible basis of an intracranial ectopic pituitary adenoma. Silent premorbid conditions were not infrequently found (up to 8.8%). In particular, the "basis" of the possible neoplasm was pre-existent, so that some triggers are necessary (e.g., pituitary tumor transforming gene, hormonal stimuli, etc.) for it to become manifest, although there was no direct morphological evidence in our findings to alter to the lesions.

P.184 Adenoid cystic salivary gland carcinoma: A review of treatment failure patterns in our centre

P.184 Adenoid cystic salivary gland carcinoma: A review of treatment failure patterns in our centre

US of the Major Salivary Glands: Anatomy and Spatial Relationships, Pathologic Conditions, and Pitfalls

Ultrasonography (US) is useful for differential diagnosis of diseases of the salivary glands. In acute inflammation, salivary glands are enlarged and hypoechoic with increased blood flow; they may contain multiple small, oval, hypoechoic areas. In chronic inflammation, salivary glands are normal sized or smaller, hypoechoic, and inhomogeneous. Sialolithiasis appears as markedly hyperechoic lines or points with distal acoustic shadowing. Sialosis appears as enlarged hyperechoic glands without focal lesions or increased blood flow. The US features of advanced Sjögren syndrome include inhomogeneous salivary glands with scattered small, oval, hypoechoic or anechoic areas, usually well defined, and increased parenchymal blood flow. Pleomorphic adenomas are usually hypoechoic, well-defined, lobulated lesions with posterior acoustic enhancement that may contain calcifications; Warthin tumors are usually oval, hypoechoic, well-defined lesions that often contain anechoic areas and are often hypervascularized. Malignant neoplasms of the salivary glands may have irregular shapes, irregular borders, blurred margins, and a hypoechoic inhomogeneous structure or may have a benign appearance. Salivary gland cysts have well-defined margins, anechoic contents, posterior acoustic enhancement, and no internal blood flow. However, US appearances of some diseases may overlap, thus producing diagnostic pitfalls.

Branchial‐like cysts of the thyroid associated with solid cell nests

Presented herein is the case of a 65-year-old man with a 20 year history of thyroid hypofunction. On sonography a cystic lesion 4 x 4 x 5 cm in largest diameter was found, replacing most of the right lobe of the thyroid gland. Microscopically, the lesion was composed of labyrinth-like cystic structures (LCS) lined by a few layers of benign-appearing squamous cells and filled by mucinous material. Adjacent to the cyst walls were discontinuous patches of a lymphoid tissue, composed of haloed centrocyte-like cells or germinal centers mostly depleted of germinal cells. Additionally, there were numerous squamous cell nests equivalent to solid cell nests (SCN), all of which were surrounded by a similar-looking lymphoid tissue. Rare SCN were thus cystically changed and contained a small amount of mucus. The SCN communicated with the LCS: the former represented the most distal outpouchings of the latter. The epithelial structures were surrounded by a loose collagenous adipocytic stroma with plump fibroblasts, which resembled the stroma often seen in lateral neck cysts associated with structures such as cartilage, accessory salivary gland tissues, cysts and accessory thyroid and thymus. Immunohistochemically, all lesional elements were negative for calcitonin and thyroglobulin. The results of the paper suggest that branchial cleft-like cyst have an origin in the ultimobranchial body.

Non-neoplastic lesions of the salivary glands: New entities and diagnostic problems

Summary The histopathology of the salivary glands is a complex and difficult area of diagnostic pathology. In the latest WHO classification there are 40 named neoplasms many of which have variable histological features that can challenge even the most experienced specialist pathologist. In addition, the salivary glands can be affected by a range of non-neoplastic conditions, some of which have only recently been described. These often present clinically like tumours and may have pathological features similar to some of the neoplasms, making diagnosis difficult and errors serious. The purpose of this paper is briefly to review non-neoplastic lesions of the salivary glands and to aid the diagnostic pathologist by describing the key histopathological features of each. The entities covered include: sclerosing polycystic adenosis, cheilitis glandularis, salivary gland hyperplasias, necrotizing sialometaplasia, subacute necrotizing sialadenitis, non-neoplastic oncocytic lesions, salivary gland cysts, lymphoepithelial cysts, polycystic (dysgenetic) disease and HIV associated cystic disease.

Thoracic ranula: an extremely rare case

We present the first case of a thoracic ranula which originated from the left submandibular area extending into the subcutaneous tissue planes of the anterior chest wall. The patient had a history of surgery for a previous benign left salivary gland cyst, and presented with an enlarging mass in the anterior chest wall. This was a recurrence of a ranula, with an extension into the anterior thoracic wall. The thoracic ranula was excised, together with ipsilateral sublingual and submandibular glands, via a transcervical approach. No recurrence was detected over a 3-year post-operative follow up.