Salivary Gland Lesions Research Articles

Potential Causes of Cytohistological Discrepancy and Utility of The Milan System in Salivary Gland Lesions – An Institutional Experience

Potential Causes of Cytohistological Discrepancy and Utility of The Milan System in Salivary Gland Lesions – An Institutional Experience

Application of The Milan System in Salivary Gland Lesions with Cytology-Surgical Correlation

Application of The Milan System in Salivary Gland Lesions with Cytology-Surgical Correlation

Tyrosine Crystals in Nasolabial Cyst - A Morphologic Curiosity Diagnosed at Cytology

Background: Tyrosine rich crystals (TC) are curious structures, rarely encountered at histopathology, more so at cytology. These crystals have been documented exceptionally in various non-neoplastic and neoplastic lesions of salivary gland, lacrimal gland and rarely in larynx. The finding of these crystals in nasolabial cyst has not been reported till date. Case: A 35-year-old female with a clinical and radiologic diagnosis of nasolabial cyst underwent fine needle aspiration cytology (FNAC). Tyrosine crystals in singles and in groups assuming ‘petaloid’ and ‘daisy head’ forms were noted along with few lymphocytes and histiocytes. Amylase crystals were also noted. Conclusion: Regardless of the precise cause, cytologic recognition of TC is important to avoid confusion. Identification of these crystals at FNAC is a matter of avid observation and encourages cytopathologist for meticulous examination of all fluids. The case also highlights that the occurrence of TC is not restricted to SG and the circumstances in which it occurs is diversified.

Assessment of cervical neck lesions with contribution of fine needle aspiration cytology: a retrospective study in western Uttar Pradesh region

Introduction: Cervical masses have probable spectrum of nonspecific inflammation to malignancy and tuberculosis. The object of the present study was to assess a number of cervical neck mass with the role of FNAC to diagnose these lesions. Materials and Methods: The characteristics were noted on pre-outlined questionnaire as regarding local investigation findings, laboratory and history of cases and patients’ personal details. Analysis of every case was depending upon cyto-morphology and clinical evaluation as cytological findings. Results: Out of 520 patients there were 254 (48.84% male and 266 were female cases. Thyroid lesions were found excessive in female (85.91%) compare to male (14%). Occurrence of lymph node was found 56.12% in male cases and 43.87% in female cases, which were slightly more in male patients. The prevalence of salivary gland lesion was found more in male (55%) compare to female (45%). Conclusion: FNAC is useful investigation in diagnosis of cervical masses.

Macrocystic (Mammary Analogue) Secretory Carcinoma: An Unusual Variant and a Pitfall in the Differential Diagnosis of Cystic Lesions in the Head and Neck.

Mammary analogue secretory carcinoma (MASC) is a relatively recently described salivary gland adenocarcinoma characterized by ETV6-NTRK3 gene fusion and in most cases indolent clinical behavior. The majority of tumors show an admixture of microcystic, solid, and tubular growth patterns but only a few cases with dominant macrocystic growth have been reported. We report 15 cases of macrocystic MASC. There were 11 men and 4 women (17 to 88 y age range, average 47 y). The patients presented with a painless cystic mass, the majority in the region of the parotid gland (n=13), as well as in submandibular gland (n=1) and the neck (n=1). All tumors were circumscribed measuring 1.0 to 4.0 cm in greatest diameter (mean: 1.75 cm). Twelve tumors were unilocular, while 3 were multilocular. The cystic spaces were predominantly lined by a single epithelial cell layer with focal areas in which the epithelium was multilayered with papillary and hobnail features. In 3 of the cases there were more solid foci of intracystic tumor characterized by papillary and/or microcystic growth. The neoplastic cells were round to oval with hyperchromatic to vesicular nuclei with centrally located nucleoli and eosinophilic or vacuolated cytoplasm. Tumor cells showed strong positivity for S100 protein and mammaglobin, while DOG1 was uniformly negative. A minority of cases showed focal p63 reactivity predominantly limited to the periphery of the cystic lining. ETV6 gene rearrangement was identified in 9 cases. Macrocystic MASC can simulate benign and malignant salivary gland lesions and needs to be included in the differential diagnosis of cystic lesions in the head and neck. To the best of our knowledge, our report represents the first series of macrocystic MASCs wholly focusing on this unusual variant.

Salivary gland involvement disparities in clinical characteristics of IgG4-related disease: a retrospective study of 428 patients.

IgG4-related disease (IgG4-RD) has recently been recognized as a fibro-inflammatory condition featuring tumefactive lesions in multiple organs, and the salivary gland is one of the most commonly involved sites. We undertook this study to compare detailed demographic, clinical and laboratory characteristics of IgG4-RD patients with salivary gland lesions (IgG4-RD SG+) and salivary-gland-free IgG4-RD (IgG4-RD SG-) in a large cohort. We carried out a retrospective review of the medical records of 428 cases of IgG4-RD diagnosed at Peking University People's Hospital between March 2006 and May 2018. Among 428 patients, 249 had salivary glands that were affected. IgG4-RD SG+ patients showed younger age at disease onset and diagnosis, and a longer interval between symptom onset and diagnosis. The IgG4-RD SG+ group involved more female patients, and allergic diseases were more common in this group. In terms of organ involvement, the IgG4-RD SG+ group were more frequently presented with lacrimal gland involvement, while lymph node, retroperitoneal fibrosis, pancreas, biliary system, kidney and aorta were more prominent in the IgG4-RD SG- group. In addition, the serum IgG4 level, IgG4/IgG ratio and IgE level were significantly higher in IgG4-RD SG+ patients. Patients with eosinophilia were more common in the IgG4-RD SG+ group, while elevated ESR, CRP and positive ANA were more common in the IgG4-RD SG- group. We have revealed demographic, clinical and laboratory differences between IgG4-RD SG+ and SG- patients, which indicated potential differences in pathogenesis and important implications for the diagnosis and management of these two phenotypes.

Histomorphological study of salivary gland lesions: A study in tertiary care centre, Bangalore

Introduction: Salivary gland lesions are morphologically and clinically diverse group of lesions which is difficult task for histomorphological interpretation. Since salivary gland tumours are uncommon owing to limited experience with them. The salivary gland system comprises three pairs of major glands (parotid, submandibular and sublingual) and about 500-1000 lobules of minor glands dispersed in the submucosa of the oral cavity. Neoplastic and non-neoplastic lesions arises from major and minor salivary glands. Materials and Methods: Present study was done for 3 years from June 2015 to June 2018. The study was done on 50 specimens from patients with salivary gland lesions which are referred to the department of pathology, DR. B R Ambedkar medical college, Bangalore, Karnataka. The gross examination was done after fixing specimen in 10% formalin and sections were stained with haematoxylin and eosin. Results: Out of 50 cases, 35 cases are neoplastic, and 15 cases are non-neoplastic. Among 35 neoplastic lesions, 20 cases are benign, and 15 cases are malignant. Most common benign tumour of salivary gland is pleomorphic adenoma followed by Warthin’s tumour. Most common malignant tumour of salivary gland is mucoepidermoid carcinoma followed by adenoid cystic carcinoma. Most common non-neoplastic lesion is chronic sialadenitis. Conclusion: From the present study, it is evident that histomorphological examination is the mainstay for the diagnosis and categorization of neoplastic and non-neoplastic lesions of salivary gland. Keywords: Salivary gland, Pleomorphic adenoma and Mucoepidermoid carcinoma.

Cytopathology approach to rare salivary gland lesions with oncocytic features.

Salivary glands located in the head and neck area are known to have different lesions with prominent oncocytic features. Fine needle aspiration is usually the initial approach in the management of these lesions, whether they represent neoplastic or non-neoplastic processes. Owing to the limited material present upon cytopathologic examination, knowledge of variants and subtypes of various oncocytic lesions that can occur in this area is of major importance to provide the most accurate interpretation to the patients and clinicians. In this article, we selected rare lesions of the salivary glands that may exhibit oncocytic changes, and provided a brief discussion of each one of them, with emphasis on challenges in navigating the differential diagnosis that these cases may pose, from the cytopathology standpoint.

Application of the Milan System for Reporting Salivary Gland Cytopathology: A retrospective study in a tertiary institute.

Fine needle aspiration (FNA) cytology has been widely used in the preoperative evaluation of salivary gland lesions. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a tiered risk-stratification scheme designed to standardize reporting and facilitate decision making. We aimed to clarify the validity and diagnostic utility of the MSRSGC-based classification of salivary gland lesions. A total of 1020 salivary gland FNA specimens were retrieved between 2008 and 2017, with histologic follow-up data available for 349 specimens. Within the present retrospective study, each specimen with follow-up data was reclassified according to the MSRSGC diagnostic categories: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), and malignant. The risk of malignancy (ROM) was calculated based on the histologic follow-up data. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the MSRSGC-based classification of the malignant potential of salivary gland lesions were 80.1%, 70.4%, 99.2%, 90.5%, and 96.7%, respectively. The ROM calculated for specimens assigned to the nondiagnostic, nonneoplastic, AUS, benign neoplasm, SUMP, SM, and malignant categories were 8.6%, 15.4%, 36.8%, 2.6%, 32.3%, 71.4%, and 100%, respectively. The present results confirm the validity and diagnostic utility of MSRSGC, supporting its use in clinical practice to help devise adequate management strategies for salivary gland lesions.

Moving toward a systematic approach for reporting salivary gland cytopathology: cytohistological correlation with the application of the Milan system for risk stratification at a tertiary care center.

Fine-needle aspiration cytology (FNAC) of salivary glands is a well-established technique that plays a critical role in the preoperative diagnosis of lesions. Despite its clinical utility, it remains one of the most challenging areas in cytopathology. This is because there is no consensus on how to report salivary gland cytopathology, which has resulted in inconsistent terminology and confusion in communication among cytopathologists and clinicians. A risk stratification of FNA diagnostic categories has been recently proposed to be useful in reporting. A retrospective study of FNAC of salivary gland lesions reported from 2014 to 2017 was performed. The performance of the cytology reporting system was evaluated with histological diagnosis serving as the gold standard. The aspirates were then categorized according to the Milan system. Furthermore, the risk of malignancy was calculated for all diagnostic categories. A total of 899 salivary gland aspirates were evaluated: 2.2% were nondiagnostic, 55.8% indicated nonneoplastic lesions, and 40.4% indicated neoplastic lesions. Histopathology was available for 172 cases. FNA had a sensitivity of 72.3% and a specificity of 92.6% with an overall diagnostic accuracy of 91.4% for differentiating malignant from benign tumors. A tiered classification scheme as proposed by the Milan system may prove helpful in effectively guiding clinical management of patients with salivary gland lesions. Our experience with this system helps to pave the way for the adoption of the Milan System for Reporting Salivary Gland Cytopathology.

Practical implication of risk based categorization of salivary gland lesions on FNAC by Milan system: A two year retrospective study

Milan system was introduced in 2018 with an objective to standardize and bring uniformity in the reporting of salivary gland lesion on fine needle aspiration. The present study is conducted retrospectively over a period of two years to reclassify salivary gland lesions according to Milan system and to calculate risk of malignancy in each category. Out of total 106 salivary gland aspiration cases, histologic follow up was available for 57 cases. On re-categorizing these lesions, maximum cases belong to neoplastic benign category. Risk of malignancy in each category were-non diagnostic (0%), non-neoplastic (25%), atypia of undetermined significance AUS (33.3%), neoplastic benign (5.3%), suspicious for malignancy (75%) and malignant (100%). Three false negative and one false positive case was identified in the study. In conclusion, Milan system is very helpful in providing a uniform reporting system for salivary gland lesions, enhancing diagnostic accuracy and providing valuable impact on their management.

Utility of cytology in head and neck pathology- A one year study

Introduction: Head and neck lesions most commonly arise in cervical lymphnodes followed by thyroid gland, soft tissues and salivary gland. Fine Needle Aspiration Cytology (FNAC) is a pre surgical procedure done on OPD (Out Patient Department) basis having advantages like; it is simple, minimally invasive, cost effective and repeatable diagnostic tool. Even though these lesions are common, clinicians routinely face problems in their diagnosis. Hence FNAC plays an important role in providing quick and accurate diagnosis guiding the clinician for appropriate treatment. Aims and objectives: 1.To study the occurrence of various head and neck lesions in this region; 2.To study the cytological features of various head and neck lesions; 3.To correlate the cytological features with clinical data; 4.To emphasize the utility of FNAC in the diagnosis of head and neck lesions. Materials and Methods: A retrospective study was conducted among 500 patients with palpable head and neck lesions including oral cavity attending GIMS Hospital Kalaburagi and the Department of Pathology Gulbarga Institute of Medical Sciences, Kalaburagi from January 2018 to December 2018. Relevant clinical details were recorded and written consent was obtained. Results: A total of 500 FNAC cases of head and neck lesions were included in the present study in which 172(34.4%) were males and 328(65.6%) were females. Patients age ranged from 8 months to 80 years. Peak incidence was seen in between 21-40 years of age. Lymph node lesions 201(40.2%), were the most common lesions followed by thyroid lesions 138(27.6%).Soft tissues 123(24.6%) and lesions from major and minor salivary glands 25(5%) were the other head and neck lesions seen in this study. Reactive lymph node hyperplasia (n=105), colloid goiter (n=78), epidermoid cyst (n= 62) and pleomorphic adenoma (n=12) were the predominant diagnosis of lymphnodes, thyroid gland, soft tissues and salivary gland lesions respectively. Secondaries to the lymph node

Video clip assessment of a salivary gland ultrasound scoring system in Sjögren’s syndrome using consensual definitions: an OMERACT ultrasound working group reliability exercise

ObjectiveTo develop ultrasound (US) definitions and a US novel scoring system for major salivary gland (SG) lesions in patients with primary Sjögren’s syndrome (pSS) and to test their intrareader and...

Sonological Evaluation of Major Salivary Gland Lesions with Histopathological Correlation

Sonological Evaluation of Major Salivary Gland Lesions with Histopathological Correlation

Implementation of the MILAN system for reporting salivary gland cytopathology: Interobserver concordance and cytohistological correlation of discordant cases.

Fine needle aspiration cytology (FNAC) plays a pivotal role in evaluating salivary gland (SG) tumors. Several studies have shown diagnostic utility of MILAN system for reporting salivary gland cytopathology (MSRSGC) by examining risk of malignancy but only an occasional study has focused on interobserver variability. Hence, the present study was undertaken to assess the agreement among cytopathologists with varying experience in SG cytopathology using MSRSGC and to re-evaluate discordant cytohistological diagnoses for possible causes of misinterpretation. All SG lesions subjected to FNAC over a period of 3½ years were studied. The cases were critically reviewed by 2 pathologists with variable experience in cytopathology using MSRSGC and concordance level among them was calculated. Cytohistological discordant diagnoses were reclassified and possible causes of misinterpretation during routine reporting were evaluated. Of 150 SG aspirates categorized according to MSRSGC, diagnostic disagreement between 2 pathologists was found in 10. Unweighted Cohen's Kappa score between consultant and resident was 0.812 (high). Among 55 cases with histological correlation, cytohistological discordance was seen in 12. True pitfalls constituted 50% of discordant cases while rest 50% were attributed to practical issues (turnaround time and heavy case load) during routine reporting. MSRSGC can be used with good reproducibility between observers with variable cytopathology experience. Heterogeneous nature of SG neoplasm is a known pitfall in FNA diagnosis of SG neoplasms. During routine reporting turnaround time, heavy case load and reporting by cytopathologists with variable experience add on to challenges faced in reporting cytopathology of SG neoplasm.

Clinical features of mucosa-associated lymphoid tissue lymphoma in head and neck

Objective:To summarize the clinical features, diagnosis and treatment of mucosa-associated lymphoid tissue(MALT) lymphoma in head and neck. Method:The clinical data of 22 hospitalizedpatients with MALT lymphoma in head and neck during the recent 18 years were analyzed retrospectively. Result: Among the 22 cases, 13 patients showed salivary gland lesions, 4 showed larynx and trachea lesions,3 showed nasopharynx lesions and 2 showed thyroid gland lesions. The clinical manifestation was occupying or compression. Among them,12 patients received chemotherapy or chemoradiotherapy,5 received surgery plus chemotherapy,3 received surgery plus radiotherapy, 1 received surgery alone and 1 received radiotherapy alone; complete response(CR) occurred in 15 patients, partial response(PR) occurred in 6 patients, and 1 was stable disease(SD). The mean follow-up time was 92(8-211) months. During the follow-up period, 18 patients survived, 4 died, the three year progression free survival(PFS) and overall survival(OS) were both 95.2%, and the fiveyear PFS and OS were 79.4% and 89.6% respectively. Conclusion:The prognosis of MALT lymphoma in head and neck was good. MALT lymphoma has no specific clinical manifestations. Chemotherapy was the main treatment. Local treatment can be conducted for patients with localized lesions. .

Retrospective analysis of South Australian pediatric oral and maxillofacial pathology over a 16-year period.

The epidemiological features and distribution of pediatric oral and maxillofacial pathology in South Australia, Australia, is unknown. The medical and dental specialties involved in the management of oral and maxillofacial pathology is also unknown. The aim of the present study was to audit oral and maxillofacial pathology specimens submitted for diagnosis in a pediatric tertiary-referral hospital setting. Histopathology records were retrieved from the Women's and Children's Hospital, Adelaide over a 16-year period. Age, sex, histopathological diagnosis, location of the lesion, and department involved were recorded. Lesions were classified into 12 categories. A total of 676 lesions involving the oral and maxillofacial region were collected from patients aged 0-18years. The mean age was 8.71years. Diagnosis was not significantly associated with sex (P=0.123). A total of 97.37% of cases were benign, with connective tissue and salivary gland lesions most frequently biopsied and more frequently biopsied by medical departments. Mucoceles (19.23%) were most commonly diagnosed, followed by dentigerous cysts (5.62%). The Department of Paediatric Dentistry submitted most specimens, followed by the Department of Otolaryngology, the Australian Craniofacial Unit, and the Departments of Paediatric Surgery and Plastics. The present study provides valuable understanding into the epidemiological features of, and the specialties involved in, oral and maxillofacial histopathology in an Australian pediatric population.

The key radiologic and cytomorphologic features of oncocytic and oncocytoid lesions of the salivary gland.

Oncocytic and oncocytoid lesions represent a distinct subset of salivary gland lesions. True oncocytic lesions of the salivary gland are entirely composed of oncocytes. These are characterized by the presence of abundant eosinophilic granules due to the presence of abundant cytoplasmic mitochondria. Oncocytic lesions of the salivary gland include oncocytosis, oncocytoma, and oncocytic carcinoma. In addition to the true oncocytic lesion, there exists another group of salivary gland lesions, which demonstrate cells with abundant and occasionally granular cytoplasm. These are often termed as "oncocytoid" lesions. The recently proposed Milan System for reporting salivary gland cytology clearly states that fine-needle aspiration specimens representing oncocytic/oncocytoid lesions of salivary gland cannot effectively distinguish between a nonneoplastic lesion, benign and malignant neoplasms. Therefore, most lesions lacking classic cytomorphologic features will be classified under the umbrella diagnostic term of "Salivary Gland Neoplasm of Uncertain Malignant Potential" (SUMP). In this review, we discuss and illustrate key clinicopathologic and radiologic features that can help the practicing cytopathologist narrow down the differential and provide the best management based diagnosis.

Histopathological study of non-neoplastic and neoplastic lesions of salivary gland

Histopathological study of non-neoplastic and neoplastic lesions of salivary gland - ACHR- Print ISSN No: - 2581-5725 Online ISSN No:- 2456-9267 Article DOI No:- 10.18231/2456-9267.2019.0013, IP Archives of Cytology and Histopathology Research-IP Arch Cytol Histopathol Res

Histopathological spectrum of salivary gland neoplasms

Histopathological spectrum of salivary gland neoplasms - JDPO- Print ISSN No: - 2581-3714 Online ISSN No:- 2581-3706 Article DOI No:- 10.18231/2581-3706.2019.0010, IP Journal of Diagnostic Pathology and Oncology-IP J Diagn Pathol Oncol