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Cytological

Spectrum Of
Salivary Gland
Dr.Ch.Sushma
Lesions 2 year P.G
nd

SVS Medical
college.

Introduction:

FNA is a popular method for


diagnostic evaluation of salivary
gland masses, due to their superficial
nature and easy accessibility for the
procedure.
Salivary gland tumors are generally
not subjected to incisional or core
needle biopsy.

In incisional and core biopsy there is


a possible risk of causing fistula or
disruption of capsule with seeding of
tumor cells and subsequent
recurrence.
There is no evidence of that FNA
causes either of complications.

Aims And Objectives:


To classify salivary gland lesions into
broad groups.
Differentiate between benign and
malignant neoplasms of salivary
glands and typify them.

Materials And Methods:


All patients(50) presented with swellings
of salivary glands during the period of
1year(2014-2015) to our department.
A 22 gauge needle fitted to 10c.c syringe
was used for the FNA, aspirates are
smeared over glass slide, alcohol fixed
and later on stained with hematoxylin
and eosin.

Observation
Total number of salivary glands
aspirated are 50.
Out of 50 cases ,3 cases were proved
uncertain.

Sex Distribution
In sex distribution females slightly outnumbered
the males in ratio of 1.2:1.

Female ; 56%

Male ; 44%

Age distribution
Age distribution, shows peak incidence in fourth
decade of the lesions.
25
20
15
10
5
0

No.of Cases

Site distribution
In our study , parotid swellings predominated
with 84% followed by submandibular(12%) and
minor salivary glands(2%)
minor salivary glands 2

Submandubular

parotid

42
0 5 10 15 20 25 30 35 40 45

Based on cytological diagnosis


In our study, neoplastic lesions were observed in 42/50 cases,
followed by non-neoplastic lesions (5/50) . Based on cytology 3/50
cases were uncertain.
45
40
35
30
25
20
15
10
5
0

Sialadenitis

Neoplasms

Uncertain

Subdivision of neoplastic cases


In our study, out of neoplastic 29
were benign and 13 malignant.

benign

malignant

Subdivision of benign neoplasms


In our study, out of 29 benign
tumours ,27 are pleomorphic
adenoma and 2 are oncocytoma
Pleomorphic
adenoma
oncocytoma

Subdivision of malignant neoplasms


In our study, out of 13 malignant tumours ,10 are
mucoepidermoic carcinoma and 2 are acinic cell
carcinoma and a single low grade salivary gland
tumor
10
9
8
7
6
5
4
3
2
1
0

Discussion
In our study of 50 cases,5 cases are non
neoplastic which were found to be sialadenitis.
42 cases are neoplastic,out of which 29 cases
are benign and 13 cases are reported as
malignant.
3 cases were reported as uncertain in which
diagnosis couldnt be made.For these cases
histopathological evaluation is adviced.

Discussion
In our study, most of the lesions are
in the age group of 41-60 years and
predominantly females.
Similarly Ritu et al*, showed M: F
1.1:1 and mean age of 35 years.

Ritu Jain, D., Madhur Kudesia, M., Ruchika Gupta, M., & Sompal Singh, M. (2013). Fine
needle aspiration cytology in diagnosis of salivary gland lesions: A study with
histologic comparison.Cytojournal,2013(10), 5-5

Discussion
In our study, parotid swellings were
observed in 84% similar to study by
Perkins Mukunyadzi et al

Perkins Mukunyadzi, M. (n.d.). Review of Fine-Needle


Aspiration Cytology of Salivary Gland Neoplasms, With
Emphasis on Differential Diagnosis.Am J Clin
Pathol,118(1), S100-S115.

Discussion
Out of 29 benign neoplastic
cases,93% cases are of pleomorphic
adenoma and 6.8% cases are
oncocytoma.
Out of 13 malignant cases, 77% of
cases are of mucoepidermoid
carcinoma and 15% of acinic cell
carcinoma and low grade salivary
gland carcinoma of 0.1 %.

Tumours of
the
Parotid gland

Tumours of the parotid gland


The parotid gland is the most common
site for salivary tumours.
Most tumours arise in the superficial lobe.
Most of tumours of the parotid gland are
benign.
Fifteen to 32% are carcinomas.

Mostly seen .
Overall, PLEOMORPHIC ADENOMA is the
most frequent SGT, comprising about
50-60% of cases.
The second most frequent benign SGT is
WARTHIN TUMOR.
MUCOEPIDERMOID CARCINOMA is the
most common malignant SGT.

Location
Swellings below the ear or
in front of the ear
Upper aspect of the neck.
Less commonly, tumours
may arise from the
accessory lobe and
present as persistent
swellings within the cheek.
Rarely, tumours may arise
from the deep lobe of the
gland and present as
parapharyngeal masses

Incidence
SGTs predominantly arise in female patients
The average age of patients with SGT is about 45 years old.
The peak incidence of most specific types is in the 6thand
7thdecades.
The highest incidence of Pleomorphic adenoma (PA),
mucoepidermoid carcinoma (MEC), and acinic cell
carcinoma is in the third and fourth decades.
In the pediatric population, the most common malignant
SGT is mucoepidermoid carcinoma.

Parotid
Epithelial
Non
tumours
Malignant
Benign
MOST
epithelial
OFTEN OF SQUAMOUS CELL ORIGIN

Classificatio
n WHO

Benign epithelial tumors

Malignant
salivary gland
tumours
Low-grade malignant tumours, e.g. acinic cell
carcinoma, are indistinguishable on clinical
examination from benign neoplasms.
High-grade malignant tumors usually present
as rapidly growing, often painless swellings in
and around the parotid gland. Presentation with
advanced disease is common, and cervical lymph
node metastases may be present.

Invasion
The facial nerve, may be directly
involved by tumors in 10 to 15% of
patients.
Trismus is associated with
involvement of the pterygoid
musculature by deep parotid lobe
malignancies.

Lymph nodal invasion


The incidence of metastatic spread to cervical lymphatics
is variable and depends on the histology, primary site, and
stage of the tumor.
Parotid gland malignancies can metastasize to the intraand periglandular nodes.
The next chain of lymphatics for the parotid is the upper
jugular nodes.
Although the risk of lymphatic metastasis is low for most
salivary gland malignancies, lesions that are considered
high grade or that demonstrate perineural invasion have a
higher propensity for regional spread.

Pleomorphic
adenoma

PA
Most common form of all salivary gland neoplasms and the majority
of the PAs occur in the parotid gland.
Incidence - 40% to 70%
usually occur in the tail of the parotid.
PA is typically a slowly growing, asymptomatic, discrete nodule most
often located in the superficial lobe of the parotid gland.
These slow growing tumors are surrounded by an imperfect pseudo
capsule traversed by fingers of tumors.
Although PAs are benign tumors, subsets of these tumors have a
tendency to recur and/or undergo malignant transformation.

Microscopically.
PA is characterized by its morphological
diversity.
It comprises epithelial and myoepithelial cells
variably arranged in a mucoid, myxoid or
chondroid background.
PA usually presents with a variably thick capsule
that on serial sectioning may be focally absent.
The lesion typically harbors few mitoses and
cytological atypia.

Pleomorphic adenoma

Pleomorphic adenoma:

Epithelial
The epithelial
component may
predominate
and in this
instance the
lesion is called
cellular PA.

Epithelial
Cell
types

Other component
The myoepithelial component may form a
fine reticular pattern or sheets of spindle
cells.
The mesenchymal tissue is mucoid, myxoid
or chondroid, and predominates in some
instances.
Osseous metaplasia or lipomatous
differentiation may be seen.

Genetics of PA
inv(8)(q12.1;q12.1)

Warthins tumor, or
papillary
cystadenoma
lymphomatosum

Warthins
Second most common benign parotid
tumor and occurs most often in older
white men.
Because of the high mitochondrial
content within oncocytes, the oncocyte
rich Warthin tumor and oncocytomas will
incorporate technetium-99m and appear
as hot spots on radionuclide scans.

Pathology
These tumors are well encapsulated
lesions with cystic and solid areas.
These tumors consist of an oncocytic
epithelial cell component arranged in
double layers, which develops cysts
and papillary projections, and a
variable amount of lymphoid tissue
often with germinal centers.
A few Warthin's tumors (about 8%)
show areas of squamous cell
metaplasia and regressive changes.

Oncocytoma
Oncocytomas are benign
neoplasms composed
ofoncocytes; the large
eosinophilic cuboidal to
columnar cells with
more than 60% of their
cytoplasmoccupied by
mitochondria.
Oncocytomas represent
less than 1% of the
salivary gland
neoplasmsand 82% to
90% of them occur in
the parotid gland

Oncocytoma
Oncocytes are one to two times the size of normal
acinar cells, display abundant granular eosinophilic
cytoplasm and a central pyknotic nucleus.
The cytoplasmic granularity is due to the
accumulation of mitochondria that may occupy
upto 60% of the cytoplasm. In contrast,
mitochondria occupy only 5.2% of the cytoplasm of
normalacinar cells.
The increased concentration of mitochondria is
accompanied by a gradual disappearance from the
cytoplasm of other cytoplasmic membrane systems
and loss of plasmalemmar specializations.

Malignant
tumors of
parotid

Mucoepidermoid carcinoma
Mucoepidermoid carcinoma is the most
common malignant tumor of the parotid
gland and can be divided into low-grade
and high-grade tumors.
High grade lesions have a propensity for
both regional and distant metastases and
corresponding shorter survival rates than
low grade mucoepidermoid carcinomas.

Mucoepidermoid carcinoma

Cords, sheets and clusters of


mucous, squamous, intermediate
and clear cells
Low to high grade, although even
high grade tumors lack marked
nuclear atypia, frequent mitotic
figures or extensive necrosis
Occasional focal sebaceous cells,
goblet-type cells, oncocytic
change, inflammatory reaction to
extravasated mucin or keratin
No squamous cell carcinoma in
situ
Low grade: mucinous and
intermediate cells with bland
nuclei form glandular spaces
High grade: solid and infiltrative
growth pattern of atypical
epidermoid and intermediate cells
with cytoplasmic clearing and
small number of mucinous cells;
<20% intracystic component

AFIP point system:


2 points

Low grade - if total score is 0-4 p

Adenoid cystic carcinoma


Cribriform
Adenoid cystic carcinoma
constitutes 10% of all
salivary neoplasms

An indolent growth
pattern and a relentless
propensity for perineural
invasion characterize
adenoid cystic
carcinoma.
Regional lymphatic
spread is uncommon

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