Salivary Gland Lesions Research Articles

English

BACKGROUND Salivary gland swelling presents with a variety of neoplastic and non-neoplastic conditions. Predicting the nature of a swelling on clinical grounds alone is rarely possible hence, further assessment with accurate imaging is a necessity. Ultrasonography is a diagnostic tool that is widely available, relatively inexpensive, non-invasive, and easily reproducible. This study was undertaken to assess the role of ultrasonography as a diagnostic aid in various salivary gland swellings. METHODS Cross sectional study was conducted for consecutive patients who came to the Radiology Department, Govt. Medical College, Thrissur, from January 2014 to January 2015. Ultrasound for clinically suspected salivary gland lesions was done. USG scanning was done by Mindray DC – 08 high resolution real time multiplanar diagnostic Ultrasound System with linear array high frequency 6 to 10 MHZ transducer having scan head of 60mm. RESULTS Out of the 67 patients who were included in the study, 34 cases were identified correctly by ultrasound examination and confirmed by clinical follow up or by histopathology. Fifteen cases were A/C sialadenitis which were confirmed clinically, 11 cases were salivary gland abscess which were confirmed clinicopathologically. Eight cases were sialolithiasis which were confirmed by histopathology. Thirtythree cases were neoplastic of which 6 were malignant and 27 were benign which were confirmed by histopathology. Of the 6 malignant lesions which were confirmed by histopathology, ultrasonography correctly identified 5 cases. All these 27 benign cases were diagnosed as benign through sonography also. However out of the 18 pleomorphic adenoma cases, 15 were correctly diagnosed by USG. Out of the 9 cases of Warthin’s tumour confirmed by histopathology, USG correctly identified 7 cases. CONCLUSIONS Ultrasonography is a valuable supplement in the diagnosis of salivary gland lesions and to distinguish neoplastic/ non-neoplastic lesion so that further management can be decided accordingly. KEY WORDS Pathology, Salivary Gland Neoplasm, Ultrasonography

Possibilities of crystallographic study of the oral cavity liquid in diagnostic of diseases of salivary glands

Relevance. Despite existing research methods, diagnosis of salivary gland diseases is difficult, so the appearance of new diagnostic methods is relevant. It is known that there is a correlation between the composition of saliva and blood serum; therefore, a crystallographic study of oral fluid is used to be markers of various diseases. By the method of wedge-shaped dehydration in blood serum specific markers of predisposition to tumor greeting were identified. The aim of this study was to determine the diagnostic value of studies of oral fluid by the method of wedge-shaped dehydration in diseases of the salivary glands. Markers of inflammatory diseases of the salivary glands, as well as markers of tumor growth (spherulitis) on salivary gland adenomas were determined.
 Materials and methods. A study of 39 patients was carried out, among them 17 people with chronic sialadenitis of the submandibular salivary gland, 9 with chronic parotitis, 7 with Sjogren’s syndrome, 6 with adenomas. The control group was 14 people. The dried film (facies) was analyzed with a medical microscope MIKMED 5 in transmitted light, with a device for observing optical anisotropy of objects and a ToupCam digital camera with subsequent video recording.
 Results. In chronic inflammatory diseases of the salivary glands, the following markers were identified: a weak severity of dendrites in a drop, the presence of an intoxication zone, the presence of yeast species of the genus Candida. With Sjogren’s syndrome, the appearance of arcade and horizontal cracks in the marginal zone was noted. With adenomas of the parotid salivary glands, tumor growth markers (spherulitis) were detected, which were not detected in other diseases of the salivary glands.
 Conclusion. Crystallographic examination of the oral fluid is an informative way to diagnose diseases of salivary glands, and can be used to conduct differential diagnosis of the nature of tumor growth in case of lesions of salivary glands.

Utility of the Milan System for Reporting Salivary Gland Cytology, with focus on the incidence and histologic correlates of atypia of undetermined significance (AUS) and salivary gland neoplasm of uncertain malignant potential (SUMP): A 3-year institutional experience.

Fine-needle aspiration (FNA) is the preferred diagnostic test for salivary gland lesions. The purpose of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is to standardize salivary gland cytology reporting and guide treatment decisions. The objective of the current study was to evaluate the utility and performance of the MSRSGC, with a focus on the cytomorphology of lesions diagnosed as atypia of undetermined significance (AUS) and salivary gland neoplasm of uncertain malignant potential (SUMP). In total, 123 salivary gland FNAs were included in the study. FNA diagnoses for all cases were reviewed and recategorized, as applicable, according to the MSRSGC. Cytohistologic correlation was performed in 51 cases that had available surgical follow-up, and the risk of malignancy (ROM) was calculated. Most FNA samples were from the parotid gland. The mean patient age was 61.4 years, and the male-to-female ratio was 1.3:1. The ROM was 0% (categories I and II; nondiagnostic and benign nonneoplastic, respectively), 50% (category III; AUS), 0% (category IVA; benign neoplasm), 40% (category IVB; SUMP), 100% (category V; suspicious for malignancy), and 100% (category VI; malignant). Sensitivity, specificity, positive predictive value, and negative predictive value were 100% each. In addition, the primary factors for an AUS diagnosis were identified as low cellularity and/or the presence of lymphocytes. The presence of oncocytes followed by cellular atypia in an otherwise classic pleomorphic adenoma were principal factors for a SUMP diagnosis. The authors report an ROM comparable to that reported in the literature, with a sensitivity and specificity of 100%, supporting adaptation of the MSRSGC into the system for reporting salivary gland cytology. In addition, the findings emphasize the need to refine criteria for AUS and SUMP, thereby improving the predictive capability and subsequent management of salivary gland lesions.

Validation of the Milan System for Reporting Salivary Gland Cytopathology and the diagnostic accuracy of FNA cytology for submandibular gland lesions.

BackgroundThe Milan System for Salivary Gland Cytopathology (MSRSGC) is a categorical system for salivary gland fine‐needle aspiration cytopathology (FNAC) developed to aid clinicians in the management of salivary gland lesions. This classification is widely studied and validated, especially in cohorts that consist of mostly parotid gland lesions. However, only sparse literature describes the use of this classification for submandibular gland lesions in particular.MethodsAll patients in the Netherlands that underwent a submandibular gland resection between January 1, 2006, and January 1, 2017, with a FNAC before resection were identified with the use of the Dutch Pathology Registry database (PALGA). All FNAC results were retrospectively classified according to the MSRSGC. The risk of malignancy was calculated for all the MSRSGC categories. The sensitivity and specificity of the MSRSGC classification were calculated for submandibular gland FNAC.ResultsA total of 837 patients who underwent 975 FNAC aspirates from the submandibular glands were included in the analysis. Risks of malignancy for each of the MSRSGC categories were 14.4% in nondiagnostic, 4.4% in nonneoplastic, 37.0% in atypia of unknown significance, 3.9% in benign neoplasms, 40.7% in salivary gland neoplasms of unknown malignant potential, 76.2% in suspected malignant, and 91.3% in malignant cytology results. The sensitivity for diagnosing malignant submandibular gland tumors was 71.6% and specificity was 98.4%.ConclusionsThe results of the present study validate the use of this classification for submandibular gland lesions. Risks of malignancy vary according to the anatomical subsites of the salivary gland lesions.Lay Summary The risks of malignancy of the various Milan System for Salivary Gland Cytopathology (MSRSGC) categories vary according to the anatomical subsite of the salivary gland lesion.The proposed management techniques of the MSRSGC are valid for use with submandibular gland lesions.

Milan scoring system in the diagnosis of salivary gland lesions for assessment of risk of malignancy

Salivary gland lesions are one of the most common encounters in clinical practice for the evaluation of which Fine needle aspiration cytology is a well-established technique nowadays. Owing to the heterogenecity and morphological overlap between the various categories of these salivary gland lesions, there was a need for a standardised procedure. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardised evidence based reporting system to assess the risk of malignancy and thus helpful for the management of these lesions. We have undertaken this study for evaluation of salivary gland lesions by this newly introduced grading system for predicting the malignant potential of these lesions.: We have done a prospective study of all the salivary gland lesions received in our department for a period of 3 years from 2016 to 2019. The clinical history, aspiration cytology and histopathological examination was done for all the cases.: We have received 225 salivary gland lesions for aspiration, but histological follow up was done in only 105 lesions, which were thus included in our study. Case distribution into different categories was done in the following way:ND (5.71%), NN (38.01%), AUS (2.57%), NB (33.34%), SUMP (1.9%), SM (2.85%), and M (15%). Overall, ROM reported were 25%, 5%, 20%, 4.4%, 33.3%, 85.7%, and 97.5%, respectively for each category. Overall, sensitivity was 83.34%, specificity was 98.01%, positive predictive value was 94.87%, and negative predictive value was 91.89%. MSRSGC is a six category scheme that was recently proposed that separates the salivary gland FNAC into distinct categories, thus increasing the specificity by limiting the number of false negative and false positive cases.

Milan system in salivary gland lesions: Its diagnostic and clinical relevance

Background: The salivary gland lesions constitute around 3–6% of all head-and-neck lesions and have always posed a diagnostic riddle for the cytopathologists around the world. Since the majority of these lesions need surgical excision, it is, therefore, important to diagnose these lesions with utmost precision to prevent over or under stage procedures. The recent adaption of Milan system of reporting aims to establish a uniform, accurate, and consensual reporting system which bridges the communication between the pathologists and the clinicians. Aims and Objectives: The current study aims to assess the diagnostic application of Milan system and aims to reclassify the lesions according to it. Materials and Methods: The current study was conducted at our institute during 1 year period. All salivary gland swellings presenting to the fine-needle aspiration cytology (FNAC) section during this period were included in the study. Along with this, records and slides of cases of salivary gland lesions were retrospectively assessed. All relevant data and radiologic findings were retrieved from the case records. FNAC was done using 23 G needle. The slides were stained with both Leishman and Papanicolaou stain wherever possible. Quantitative data were expressed as mean and standard deviation and percentages. All the 83 lesions were reclassified as per the Milan system. Histopathology was available in 42 cases. Inclusion criteria: All the samples of the patient having salivary gland lesion(s) whose FNAC were performed in the department of pathology. Statistical Analysis: Data were be entered into Microsoft Excel spreadsheets. For quantitative data, mean and standard deviation were calculated. For qualitative data, percentage and proportion were calculated. Sensitivity, specificity, and spearman correlation between FNAC and histopathology were calculated. P<0.05 was considered statistically significant. Results: The total of 83 cases was included in our study. The cytological analysis was done and all cases were classified as per Milan system. The age of patients ranged from 4 years to 77 years with a mean age of 43 years. Parotid was the most frequently involved gland in which a total of 51 cases (61.4%) were reported. The most common benign tumor reported on cytology was pleomorphic adenoma and the most common malignant tumor reported was adenoid cystic carcinoma. On recategorization of lesions as per Milan system, the category IVA, that is, benign salivary gland neoplasm had the maximum number of lesions (40) accounting for 48.1% of all the lesions. Histopathology was available in 42 cases. The predominant lesion on histopathology was pleomorphic adenoma (22). On statistical analysis of the data, the sensitivity was 71.4%, specificity was 96.1%, diagnostic accuracy as 62.1%, and positive and negative predictive value as 83.3 and 92.5%, respectively. Conclusion: Risk stratification approach in classifying salivary gland cytology aspirate as per Milan system provides a standardized reporting and better communication to clinician.

Role of Fine Needle Aspiration Cytology (FNAC) in Preoperative Diagnosis of Parotid and Submandibular Gland Neoplasm

Background: The overall incidence of salivary gland neoplasm is 2.5-3.0 per 100000 per year. Salivary gland malignancies account for about 5% of head-neck malignancies. Though, it is uncommon but not rare in our country. Fine Needle Aspiration Cytology (FNAC) has been widely used for many years as a method for assessing salivary gland lesion preoperatively. It is a simple, quick, inexpensive and minimally invasive technique used to diagnose different types of salivary gland neoplasm. Objectives: To see the frequency of malignancy in parotid and submandibular salivary gland neoplasm and also to find out the role of FNAC in their preoperative diagnosis. Histopathological examination of the resected parotid and submandibular gland neoplasm was considered as gold standard to compare FNAC report of this study. Methods: This was a cross – sectional study which was conducted in the Department of Otolaryngology – Head & Neck Surgery, Dhaka Medical College Hospital, Dhaka from January 2017 to June 2018. Purposive sampling method was used to collect data. Pre-tested structured data sheet was used to record information. After collection, data were edited by meticulous checking and re-checking. Data were analyzed using SPSS for windows version 22. Results: After histopathological confirmation of the resected specimen, most common benign parotid tumour was pleomorphic adenoma 76.7% followed by warthin’s tumour 16.7%. In benign submandibular gland neoplasm, pleomorphic adenoma was the commones 87.5% followed by haemangioma 12.5%. Commonest malignant tumour of submandibular gland was adenoid cystic carcinoma 50.0%. In our study sensitivity of FNAC was 75.0%, specificity 94.74% and overall accuracy was 90%. Positive predictive value and negative value were 81.82% and 92.31% respectively. Conclusion: It can be concluded that fine needle aspiration cytology is a safe, cheap and useful preoperative diagnostic tool in the diagnosis of malignancy in parotid and submandibular gland, but as fine needle aspiration cytology partly depends on operator skill, it may give false negative and false positive result. Bangladesh J Otorhinolaryngol 2021; 27(2): 124-129

Accuracy of the Milan System for Detecting Neoplastic vs Non-Neoplastic Salivary Gland Lesions: A Retrospective Review

Abstract Introduction/Objective Overlapping morphology and heterogeneity of salivary gland tumors (SGT) poses a diagnostic challenge. FNA is commonly used diagnostic tool for evaluation of superficial and deep lesions of any site, but above limitations restrict its maximum utility. To standardize reporting and to address above limitations, Milan system (MS) of reporting salivary gland cytology, has been developed and implemented by labs. We conducted a retrospective study, applying MS to salivary gland lesions (SGL) to evaluate its accuracy and usefulness in discriminating between neoplastic and non-neoplastic conditions, and thus directing patient management (PM) Methods/Case Report 10 yr retrospective review was performed to include patients with FNA for SGL, cytology diagnosis categorized using MS, cytology-histology (CH) correlation performed, and patients’ charts reviewed for follow up. Attention given to diagnostic discrepancies between MS categories and the histologic diagnosis Results (if a Case Study enter NA) 152 patients (20-88yrs) were retrieved, peak incidence 40-49 yrs; M:F ratio 1.2:1. Distribution of the cases in the MS categories: Non-diagnostic (ND) 24, Non-neoplastic (NN) 33, Atypia of Undetermined Significance (AUS) 4, Neoplasm (N) 71, Suspicious for malignancy (SUN) 7, and Malignant (M) 10. 60 cases identified with follow-up histology, of which 51 cases were correlated, distributed as 4 ND, 4 NN, 0 AUS, 37 N, 3 SUN, and 3 M. The uncorrelated 9 cases were distributed as 4 ND due to scant sampling; 2 NN, histologically Warthin’s tumor and sialolipoma; 2 AUS, histologically basal cell neoplasm and infarcted Warthin’s tumor; 1 malignant, histologically cystic mucoepidermoid carcinoma; 0 cases for neoplastic and suspicious for malignancy categories Conclusion Milan System is a useful cytologic tool for diagnosing and segregating patients with salivary gland pathologies, however, our study shows MS to be more reliable diagnostic tool with higher accuracy (combined 98%) in N, SUN & M categories as compared to ND, NN & AUS categories (combined 50%)

Fine-Needle Aspiration Cytology: A Reliable Tool in the Diagnosis of Salivary Gland Lesions.

Salivary gland lesions comprise for about 2-6.5% of all head and neck neoplasms in adults. They are accessible for FNAC (Fine Needle Aspiration Cytology). The risk of fistula formation and/or tumour implantation are low compared to surgical biopsy. FNAC can also provide a distinction between asalivary and non-salivary lesion, benign and malignant lesions. 67 patients were studied prospectively over 5years. FNAC was performed pre-operatively and histopathological examination post-operatively in patients who underwent surgery and were willing to participate in the study. 59.7% of the lesions were non-neoplastic and 58.2% were neoplastic (37.3% benign and 20.8% malignant). Pleomorphic adenoma was the most common benign neoplasm while mucoepidermoidand adenoid cystic carcinoma both were the most frequent malignant lesion. Among the non-neoplastic lesions, the most number of cases were of chronic sialadentis. In our study, FNAC has a sensitivity of 94.54% specificity of 80.95% for neoplastic lesions. It was seen that FNAC was a useful diagnostic tool in the evaluation of salivary gland lesions because of its simplicity, excellent patient compliance and rapid diagnosis. This cost effective tool is invaluable in planning the surgical management of the patient.

Clinician's commentary: Atypia in salivary gland fine needle aspiration.

Due to the heterogenicity and morphological overlap among the broad spectrum of benign and malignant salivary gland lesions, cytopathology result interpretations can be challenging and variable even among the most experienced head and neck pathologist. There was no standardization of cytopathology result reporting until the recently proposed "Milan system for reporting salivary gland cytopathology" (MSRSGC). MSRSGC may offer more clarity and help minimize ambiguity, but surgeons, as part of multidisciplinary teams, do not only rely on the tiered stratification and risk of malignancy assessment. With only the MSRSGC reported, there may be critical information missing from the overall diagnostic evaluation of salivary gland masses. Cytopathologist evaluation, description of findings, and expert interpretation of the fine-needle aspiration cytology along with differential diagnosis can be critical pieces of information, that is, utilized in management discussions with patients and their families. This information needs to be included in every cytopathology interpretation in addition to the MSRSGC classification. In clinical practice, decisions concerning salivary gland tumor management are not based on single examinations but incorporate information from multiple sources including patient histories, clinical symptoms and signs, physical examinations, imaging studies, and when available, cytopathology. Additional cytopathology information will likely help to improve the utility and predictive power of MSRSGC, similar to Bethesda Classification and the predictive importance of nuclear atypia in indeterminate thyroid biopsy material for thyroid neoplasms.

Sclerosing Polycystic Adenoma: Conclusive Clinical and Molecular Evidence of Its Neoplastic Nature.

Sclerosing polycystic adenosis, initially considered a non-neoplastic salivary gland lesion and classified as such in the 2017 WHO Classification of Head and Neck Tumors, has been the subject of controversy regarding its possible neoplastic nature. The reporting of recurrent PI3K pathway alteration represents evidence to support these lesions as being neoplastic and more appropriately referred to as sclerosing polycystic adenoma (SPA). Herein, we provide additional evidence that supports the classification of SPA as a true neoplasm. Eight cases of SPA were identified in our database and consultation files. All cases were subjected to PTEN immunohistochemistry (IHC) and next-generation sequencing (NGS). In addition, one patient underwent genetic counseling and germline testing. The cases included 5 men and 3 women with a mean age of 41years (range 11-78) and all tumors arose in the parotid gland. One patient had multiple recurrences over a period of 2years. Morphologically the tumors were circumscribed and characterized by an admixture of acini, ducts and cysts embedded in a fibrotic/sclerotic stroma. The cells lining the ducts and cysts showed variable granular, vacuolated, foamy and apocrine cytoplasmic features, as well as acinar cells contained intracytoplasmic brightly eosinophilic granules. The apocrine intraductal proliferations showed mild to moderate atypia in 6 cases. One case showed overt malignant morphology that ranged from intraductal carcinoma to invasive salivary duct carcinoma. Seven cases tested for PTEN IHC showed loss of nuclear expression in the acinar and ductal cells with retained PTEN expression in the myoepithelial cell and stroma. NGS detected PIK3CA or PIK3R1 genetic alterations in 7 cases, including a novel TFG-PIK3CA fusion. Coexisting PTEN mutations were seen in 4 cases, including in a patient with clinical stigmata of Cowden syndrome and confirmed by germline genetic testing. Our findings herein documented including recurrence of tumor, malignant transformation, high prevalence of PI3K pathway oncogenic alterations and the possible heretofore undescribed association with Cowden syndrome add support to classifying SPA as true neoplasms justifying their designation as adenoma, rather than adenosis.

Risk stratification by application of Milan system for reporting salivary gland cytopathology: A tertiary care experience.

Objectives:The Milan system for reporting salivary gland cytopathology (MSRSGC) classification has been proposed to improve reproducibility in the management of salivary gland lesions. Fine-needle aspiration cytology (FNAC) is a widely accepted, well-tolerated, cost-effective, minimally invasive diagnostic method for pre-operative evaluation of salivary gland lesion that aids management decisions. The present study aims to reclassify the salivary gland FNAC aspirates by applying MSRSGC and calculating the risk of neoplasm and malignancy for each diagnostic category.Material and Methods:The present study is a retrospective observational study done for 54 months. A total of 168 cases of salivary gland FNA, 54 cases were excised in our institute for histopathology. Retrospective reviews were performed, and the FNAC cases were reclassified according to the Milan system, and the results of FNAC and final histology were correlated, wherever available. Furthermore, the risk of malignancy was calculated for all the diagnostic categories. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of FNAC were determined.Results:In the present study, the age of patients ranged from 3 to 86 years, with a mean age of 39 years. Among all the patients, 61.3% were male, and 38.6% were female. However, only 54 salivary gland FNA samples for which histopathology was available were categorized into six categories. Among them, category IV (neoplastic) had a maximum number of cases of 66.6%. The rate of malignancy was calculated for all diagnostic categories as follows: (1) Non-diagnostic: 0.0%, (2) non-neoplastic 0.0%, (3) atypia of undermined significance 100%, (4a) benign 5.5%, (4b) uncertain malignant potential 33.33%, (5) suspicious for malignancy 00%, and (6) malignancy 80%. The sensitivity, specificity, PPV, NPV, and DA for differentiating between benign and malignant neoplasm were 36.3%, 94.4%, 66.6%, 82.9%, and 80%. Two false-positive and seven false-negative neoplastic cases were noted.Conclusion:FNAC is a reliable, minimally invasive diagnostic method with high DA for diagnosing salivary gland lesions. Most salivary gland lesions can be accurately diagnosed on FNAC with adequate sampling and cytopathologists experience.

Cytomorphological Spectrum of Salivary Gland Lesions by Fine Needle Aspiration Cytology

Introduction: Salivary gland lesions encompass a baffling subset of lesions with overlapping morphologies on cytomorphology, due to their heterogenous histologies and rare enough to sometimes bewilder even the most knowledgeable cytopathologists. The technique of fine needle aspiration (FNA) cytology in the evaluation of salivary gland lesion is simple to perform, saves time, reliable, safe and inexpensive. FNA is highly accurate when used in proper clinical setting and supported by appropriate clinical and relevant diagnostic data. Rapidity of obtaining a pathological diagnosis allows more intelligent therapeutic approach. Materials and Methods: It was a prospective study carried out in the cytology section of pathology department for a period of two years using fine needle aspiration as a diagnostic tool as per standard protocol. The clinical and radiological data were obtained from the patient’s case papers and collaboration with the operating surgeon, the lesions were analysed on cytology. Haematoxylin & Eosin, Papanicolaou stain and Giemsa were used as standard stains. Results: A total of 66 cases of salivary gland lesions were aspirated for a period of two years. Majority of cases were in the age group of 21-30 years with 36 male patients (55%) and 30 female patients (45%). About 44(66.7%), 19(28.8%), 1(1.5%) and 2(3.0%) cases occurred in parotid gland, submandibular gland, sublingual gland and minor salivary gland respectively. There were 21(32%) cases of non-neoplastic lesions and 45(68%) cases of neoplastic lesions. Histopathological specimens were available in 11 out of 66 cases and showed correlation with cytological findings. Conclusion: Fine needle aspiration cytology of salivary gland lesions has high diagnostic accuracy, helps in appropriate therapeutic management and is useful as a diagnostic procedure because of the availability of earlier diagnosis in comparison with the histopathology. Keywords: Salivary gland lesions, fine needle aspiration cytology, neoplastic, non-neoplastic.

The Role of Immunohistochemistry for Primary Oral Diagnosis in a Brazilian Oral Pathology Service.

A proper antibody panel selection is one of the most important factors to reach an adequate diagnosis in challenging cases. This retrospective study was designed to determine the contribution of immunohistochemistry (IHC) in the primary diagnosis of oral diseases in one of the main services of oral pathology in the State of São Paulo, Brazil, and to identify the most common antibodies used, and recommend diagnostic algorithms based on our experience with challenging lesions. A total of 1698 IHC stains were performed in 401 cases from a total of 28,804 cases received from public dental clinics and private dental practitioners within a period of 13 years, representing a frequency of 1.4% of IHC solicitations. Among these, 112 (28%) were mandatory to reach a final diagnosis and 255 (63.6%) were confirmative. In 34 (8.4%) cases, it was not possible to reach a conclusive/final diagnosis, even with IHC. Regarding the nature of the lesions, 210 (52.3%) were benign, 163 (40.6%) were malignant tumors, 13 (3.2%) were reactive, 10 (2.5%) were premalignant, and 5 (1.2%) were lesions of uncertain malignancy. Small amount of tissue of some incisional biopsies, overlapping features of spindle cell lesions (epithelial, neural, melanocytic, smooth muscle, endothelial, and fibroblastic/myofibroblastic cell differentiation), and overlapping features of salivary gland lesions were the most frequent challenges in which IHC stains were requested. Spindle cell lesions were the most frequent (22%) among all cases that required IHC to reach a final diagnosis. The implementation of IHC for routine practice requires a wide range of markers, proper antibody selection, and knowledge to interpret the subjectivity of staining. The inherent limitation of incisional biopsies was pointed as a reason to inconclusive diagnosis, despite a wide range of antibodies that our laboratory displays.

Mélange of Lymphoepithelial Lesions of Salivary Glands from a Tertiary Care Center of North East India: Diagnostic Conundrums

Background Lymphocytic infiltrates of the major salivary glands are involved in a spectrum of diseases that range from reactive to benign and malignant neoplasms. Occasionally, these pathologic entities present difficulties in the clinical and pathological diagnosis. Aim and Objective The aim of this study was to highlight the importance of meticulous cytopathological and histopathological examination (HPE) in solving the diagnostic challenges encountered in the analysis of these salivary gland lesions. Materials and Methods A retrospective analysis of salivary gland lesions was undertaken over a period of 5 years from 2013 to 2018 in the Department of Pathology at our institute. Salivary gland pathologies diagnosed either as chronic sialadenitis or reactive/benign/malignant lymphoepithelial lesions on fine-needle aspiration cytology (FNAC) and as lymphoepithelial carcinoma (LEC) were included in this study. Results A total of 86 cases of salivary gland lesions diagnosed as mentioned above were found during this period. Out of the 86 cases, 16 were subjected to HPE. Biopsy was not warranted in most of the cases diagnosed as chronic sialadenitis. HPE was concordant with the FNAC diagnoses in 13 out of the 16 cases (81.3%), with a single case misinterpreted as LEC on FNAC. Conclusion Benign and malignant lymphoepithelial lesions of salivary glands may sometimes be difficult to differentiate not only from one another on FNAC but also from other malignant lesions. FNAC is an effective tool for the diagnosis of nonneoplastic lesions, but in cases of benign lymphoepithelial lesions in the absence of salivary acini, biopsy is advisable.

Assessment of Milan System for Reporting Salivary Gland Pathology-Cytodiagnostic Appraisal

Background: Fine-needle aspiration cytology (FNAC) is a well-established technique for the evaluation of salivary gland lesions, but because of the heterogenicity and morphological overlap between the spectrum of the lesion, there are a few challenges in its wide use. Recently, “The Milan system for reporting salivary gland cytopathology” was introduced, providing guide for diagnosis and management according to the risk of malignancy (ROM) in different categories. The present study was conducted to assess the Milan System for Salivary Gland Cytopathology on salivary gland lesion aspirate and to correlate the reporting categories with conventional reporting methods and to use as objective tool in implication and uniformity at the management of salivary gland lesions. Materials and Methods: A total of 102 cases of salivary gland lesion were enrolled in the study, who underwent FNAC in the division of cytopathology. The FNA results of this study were recategorized according to the Milan system and compared with the final histopathological diagnosis. Results: Milan system FNAC sensitivity was 82.5%; specificity was 90.90%, while the diagnostic accuracy was 84.31%. The positive and negative predictive values were 97.05% and 58.82%, respectively. ROM was calculated for each category. It was 33.3% in Cat I, 9.0% in Cat II, 100% in Cat III, 9.3% in Cat IV A, rest 100% in the remaining categories. Conclusion: The present study concluded that the Milan system has cytodiagnostic advantages over the conventional reporting system. It has the advantage to know the ROM and as a systematic nomenclature, it may reduce the rate of surgery where it was not indicated.

Non-neoplastic Lesions among Lateral Neck Mass Specimens in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Lateral neck masses present clinically as neoplastic or non-neoplastic lesions of lymph nodes, salivary glands, and thyroid. Non-neoplastic lesions, if evaluated timely, may not transform into malignancy thus reducing clinical burden. A cytomorphological study using fine needle aspiration is a reliable method for the diagnosis of such masses. The aim of this study was to find out the prevalence of non-neoplastic lesions of lateral neck mass specimens received in the Department of Pathology in a tertiary care center. This descriptive cross-sectional study was carried out in the Department of Pathology among lateral neck mass specimens of a tertiary care center from January 2019 to December 2020 after obtaining ethical approval from the Institutional Review Committee (Reference no: 155/19). A convenience sampling method was used and data analysis was done in Microsoft Excel 2019. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 300 lateral neck mass specimens, non-neoplastic lesions were found in 246 (82%) (77.7-86.3 at 95% Confidence Interval). The involvement of lymph nodes in 117 (47.6%) was the most common finding followed by thyroid 112 (45.5%). Among non-neoplastic lesions, the cytomorphological features of benign nodular goiter 93 (37.8%) was the most common lesion followed by reactive lymphoid hyperplasia 73 (29.7%). The study showed that the prevalence of non-neoplastic lesions was similar to that of other national and international studies.

Non Infiltrating Oral Angiolipoma – Report of A Rare Case with Review

The clinical presentation of typical lipomas is often characteristic. But the variations of lipoma based on the associated stroma poses a challenging picture with clinical diagnosis varying from benign tumors, various inflammatory and reactive lesions, salivary gland lesions, to few peripheral odontogenic lesions. Only a thorough clinical and pathological evaluation and correlation will help in arriving at a conclusive diagnosis, in understanding the behaviour, planning the treatment and predicting the prognosis of the lesion. One such case of lipoma presenting as an unassuming swelling clinically, but showing exuberant vascular component occurring on buccal mucosa is presented. A review of this variant of lipoma is discussed in comparison with the present case.

A rare case of sclerosing polycystic adenosis of parotid gland

The parotid gland tumors are classified according to their morphological and histological patterns. The most common site of presentation of a salivary neoplasm is the parotid gland. Sclerosing polycystic adenosis (SPA) is a rare disease of the salivary glands, first described by Smith et al at 1996. We report a case of 61 year gentleman admitted in KVG Medical college and hospital with complains of swelling in right side of face since 6 months. Local examination of right parotid region showed solitary swelling with ipsilateral mandibular lymphadenopathy. EBV profile was positive. CT head and neck revealed an enlarged right sided parotid gland resembling features of Pleomorphic adenoma. Fine needle aspiration of gland showed features of chronic sialo-adenitis. A provisional diagnosis of Pleomorphic Adenoma was made. Patient underwent superficial parotidectomy. Histopathology of the operated specimen had features suggestive of Sclerosing polycystic adenosis of parotid gland. Patient was followed up for a period of one year and he had no recurrence. To conclude, Sclerosing polycystic adenosis of the parotid gland is a rare benign salivary gland lesion with histologic analogies to sclerosing adenosis of the mammary gland. Complete surgical excision is the reference treatment, to reduce the risk of recurrence and/or evolution.

Adenomatoid Hyperplasia: Case Report of a Rare Lesion in Uncommon Location

Adenomatoid hyperplasia is a rare lesion of the minor salivary glands recognized by localized swelling that mimics a neoplasm. This so-called pseudotumor usually occurring in adults 4th to 6th decade of life mostly, in 80%, occurs as a unilateral swelling without ulcer on the hard and soft palate. The pathogenesis of this condition is not well known but local trauma might have a role. In this case report three cases of adenomatoid hyperplasia have been reported to bring attention to this lesion as it is clinically similar to many soft tissue lesions of oral mucosa so should be considered while making a clinical diagnosis. Also, Pathologists should investigate a proper sample size under a microscope not to confuse a normal salivary gland adjacent to salivary gland tumours with Adenomatoid hyperplasia.