Fine Needle Aspiration Cytology of High Grade Neoplasm and Spindle Cell Lesion of Salivary Gland

침샘에 발생하는 고등급 악성 종양과 방추세포 병변의 세침흡인 세포소견에 대한 고찰

  • Oh, Young-Lyun (Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 오영륜 (성균관대학교 의과대학 삼성서울병원 병리과)
  • Published : 2005.11.30

Abstract

Fine needle aspiration cytology (FNAC) is a very useful tool in the preoperative diagnosis of lesions of the salivary gland. Surgical therapy of high-grade malignancies (salivary duct carcinoma, mucoepidermoid carcinoma, squamous cellcarcinoma, carcinoma ex pleomorphic adenoma, small cell carcinoma, and sebaceous carcinoma) is different from that of benign lesions or low-grade malignancies. Therefore, the recognition of high-grade malignancies is important in salivary gland FNAC. Although recognition of high-grade malignancies of the salivary gland by FNAC is not difficult, precise classification of these malignancies is often impossible. Additionally, because of its rarity, FNAC of spindle cells and mesenchymal lesions of the salivary glands is a tool that is not familiar to many cytopathologists. The characteristic cytomorphologic features of these lesions are reviewed here with a discussion of specific diagnostic problems.

Keywords

References

  1. Schindler S, Nayar R, Dutra J, Bedrossian CW. Diagnostic challenges in aspiration cytology of the salivary glands. Semin Diagn Pathol 2001;18:124-46
  2. Stewart CJ, MacKenzie K, McGarry GW, Mowat A. Fineneedle aspiration cytology of salivary gland: a review of 341 cases. Diagn Cytopathol 2000;22:139-46 https://doi.org/10.1002/(SICI)1097-0339(20000301)22:3<139::AID-DC2>3.0.CO;2-A
  3. el Hag IA, Chiedozi LC, al Reyees FA, Kollur SM. Fine needle aspiration cytology of head and neck masses: seven years' experience in a secondary care hospital. Acta Cytol 2003;47:387-92 https://doi.org/10.1159/000326538
  4. Batsakis JG, Sneige N, el.Naggar AK. Fine-needle aspiration of salivary glands : its utility and tissue effects. Ann Otol Rhinol Laryngol 1992;101:185-8 https://doi.org/10.1177/000348949210100215
  5. Frable MA, Frable WJ. Fine.needle aspiration biopsy of salivary glands. Laryngoscope 1991;101:245-9
  6. Qizilbash AH, Sianos J, Young JE, Archibald SD. Fine needle aspiration biopsy cytology of major salivary glands. Acta Cytol 1985;29:503-12
  7. Chhieng DC, Cohen JM, Cangiarella JF. Fine.needle aspiration of spindle cell and mesenchymal lesions of the salivary glands. Diagn Cytopathol 2000;23:253-9 https://doi.org/10.1002/1097-0339(200010)23:4<253::AID-DC8>3.0.CO;2-0
  8. Kleinsasser O, Klein HJ. Speichelgangearcarcinoma: ein den Milchgangcarcinomen der Brustdru¨se Analoge Gruppe von Speichldru¨sentumoren. Arch Klin Exp Ohren Nasen Kehlkopfheil 1968;192:100-15 https://doi.org/10.1007/BF00301495
  9. Ellis GL, Auclair PL. Other malignant epithelial neoplasms. In: Ellis GL, Auclair PL, eds. Atlas of Tumor Pathology. Tumors of the Salivary Glands. Washington, DC: Armed Forces Institute of Pathology, 1996:324-33
  10. Bradwein MS, Jagirdar J, Patil J, Biller H, Kaneko M. Salivary duct carcinoma (cribriform salivary carcinoma of excretory ducts): a clinicopathologic and immunohistochemical study of 12 cases. Cancer 1990;65:2307-14 https://doi.org/10.1002/1097-0142(19900515)65:10<2307::AID-CNCR2820651024>3.0.CO;2-1
  11. Lewis JE, McKinney BC, Weinland LH, Ferreiro JA, Olsen KD. Salivary duct carcinoma. Clinicopathologic and immunohistochemical review of 26 cases. Cancer 1996;77: 223-30 https://doi.org/10.1002/(SICI)1097-0142(19960115)77:2<223::AID-CNCR1>3.0.CO;2-N
  12. Delgado R, Klimstra D, Albores.Saavedra J. Low grade salivary duct carcinoma. A distinctive variant with a low grade histology and a predominant intraductal growth pattern. Cancer 1996;78:958-67 https://doi.org/10.1002/(SICI)1097-0142(19960901)78:5<958::AID-CNCR4>3.0.CO;2-8
  13. Fan CY, Wang J, Barnes EL. Expression of androgen receptor and prostatic specific markers in salivary duct carcinoma: an immunohistochemical analysis of 13 cases and review of the literature. Am J Surg Pathol 2000;24:579-86 https://doi.org/10.1097/00000478-200004000-00014
  14. Jaehne M, Roeser K, Jaekel T, Schepers JD, Albert N, Loning T. Clinical and immunohistologic typing of salivary duct carcinoma: a report of 50 cases. Cancer 2005;103: 2526-33 https://doi.org/10.1002/cncr.21116
  15. Elsheikh TM, Bernacki EG, Pisharodi L. Fine.needle aspiration cytology of salivary duct carcinoma. Diagn Cytopathol 1994;11:47-51 https://doi.org/10.1002/dc.2840110111
  16. Fyrat P, Cramer H, Feczko JD , et al. Fine needle aspiration biopsy of salivary duct carcinoma: report of five cases. Diagn Cytopathol 1997;16:526-30 https://doi.org/10.1002/(SICI)1097-0339(199706)16:6<526::AID-DC11>3.0.CO;2-K
  17. Khurana KK, Pitman MB, Powers CN, Korourian S, Bardales RH, Stanley MW. Diagnostic pitfalls of aspiration cytology of salivary duct carcinoma. Cancer (Cancer Cytopathol) 1997;81:373-8
  18. Klijanienko J, Vielh P. Cytologic characteristics and histomorphologic correlations of 21 salivary duct carcinomas. Diagn Cytopathol 1998;19:333-7 https://doi.org/10.1002/(SICI)1097-0339(199811)19:5<333::AID-DC4>3.0.CO;2-P
  19. Klijanienko J, Vielh P. Fine needle sampling of salivary gland lesions IV. Review of 50 cases of mucoepidermoid carcinoma with histologic correlation. Diagn Cytopathol 1997;17:92-8 https://doi.org/10.1002/(SICI)1097-0339(199708)17:2<92::AID-DC3>3.0.CO;2-Q
  20. Klijanienko J, Vielh P. Fine needle sampling of salivary gland lesions VI. Cytology of 44 cases of primary salivary squamous cell carcinoma with histologic correlation. Diagn Cytopathol 1998;18:174-8 https://doi.org/10.1002/(SICI)1097-0339(199803)18:3<174::AID-DC2>3.0.CO;2-E
  21. Abdul.Karim FW, Weaver MG. Needle aspiration cytology of an oncocytic carcinoma of the parotid gland. Diagn Cytopathol 1991;7:420-2 https://doi.org/10.1002/dc.2840070417
  22. Harrison RF, Smallman LA, Young JA, Watkinson JC. Oncocytic carcinoma of the parotid gland: a problem in fine needle aspiration diagnosis. Cytopathology 1995;6:54-8 https://doi.org/10.1111/j.1365-2303.1995.tb00009.x
  23. Healey WV, Perzin KH, Smith L. Mucoepidermoid carcinoma of salivary gland origin. Classification, clinicalpathologic correlation, and results of treatment. Cancer 1970;26:368-88 https://doi.org/10.1002/1097-0142(197008)26:2<368::AID-CNCR2820260219>3.0.CO;2-K
  24. Thorvaldsson SE, Beahrs OH, Woolner LB, Simons JN. Mucoepidermoid tumors of the major salivary glands. Am J Surg 1970;120:432-8 https://doi.org/10.1016/S0002-9610(70)80002-2
  25. Spiro RH, Huvos AG, Strong EW. Cancer of the parotid gland. A clinicopathologic study of 288 primary cases. Am J Surg 1975;130:452-9 https://doi.org/10.1016/0002-9610(75)90483-3
  26. Guzzo M, Andreola S, Sirizzotti G, Cantu G. Mucoepidermoid carcinoma of the salivary glands: clinicopathologic review of 108 patients treated at the National Cancer Institute of Milan. Ann Surg Oncol 2002;9:688-95 https://doi.org/10.1007/BF02574486
  27. Goode RK, Auclair PL, Ellis GL. Mucoepidermoid carcinoma of the major salivary glands. Clinical and histopathologic analysis of 234 cases with evaluation of grading criteria. Cancer 1998;82:1217-24 https://doi.org/10.1002/(SICI)1097-0142(19980401)82:7<1217::AID-CNCR2>3.0.CO;2-C
  28. Kumar N, Kapila K, Verma K. Fine needle aspiration cytology of mucoepidermoid carcinoma. A diagnostic problem. Acta Cytol 1991;35:357-9
  29. Cohen MB, Fisher PE, Holly EA, Ljung BM, Lowhagen T, Bottles K. Fine needle aspiration biopsy diagnosis of mucoepidermoid carcinoma. Statistical analysis. Acta Cytol 1990;34:43-9
  30. Zajicek J, Eneroth CM, Jakobsson P. Aspiration biopsy of salivary gland tumors. VI. Morphologic studies on smears and histologic sections from mucoepidermoid carcinoma. Acta Cytol 1976;20:35-41
  31. Layfield LJ, Glasgow BJ. Diagnosis of salivary gland tumors by fine.needle aspiration cytology: a review of clinical utility and pitfalls. Diagn Cytopathol 1991;7:267-72 https://doi.org/10.1002/dc.2840070311
  32. LiVolsi VA, Perzin KH. Malignant mixed tumors arising in salivary glands. I. Carcinomas arising in benign mixed tumors: a clinicopathologic study. Cancer 1977;39:2209-30 https://doi.org/10.1002/1097-0142(197705)39:5<2209::AID-CNCR2820390540>3.0.CO;2-8
  33. Spiro RH, Huvos AG, Strong EW. Malignant mixed tumor of salivary origin: a clinicopathologic study of 146 cases. Cancer 1977;39:388-96 https://doi.org/10.1002/1097-0142(197702)39:2<388::AID-CNCR2820390204>3.0.CO;2-D
  34. Nigam S, Kumar N, Jain S. Cytomorphologic spectrum of carcinoma ex pleomorphic adenoma. Acta Cytol 2004;48:309-14 https://doi.org/10.1159/000326378
  35. Lewis JE, Olsen KD, Sebo TJ. Carcinoma ex pleomorphic adenoma: pathologic analysis of 73 cases. Hum Pathol 2001;32:596-604 https://doi.org/10.1053/hupa.2001.25000
  36. Olsen KD, Lewis JE. Carcinoma ex pleomorphic adenoma: a clinicopathologic review. Head Neck 2001;23:705-12 https://doi.org/10.1002/hed.1100
  37. Anand A, Brockie ES. Cytomorphological features of salivary duct carcinoma ex pleomorphic adenoma: diagnosis by fine.needle aspiration biopsy with histologic correlation. Diagn Cytopathol 1999;20:375-8 https://doi.org/10.1002/(SICI)1097-0339(199906)20:6<375::AID-DC9>3.0.CO;2-L
  38. Klijanienko J, El.Naggar AK, Servois V, Rodriguez J, Validire P, Vielh P. Mucoepidermoid carcinoma ex pleomorphic adenoma: nonspecific preoperative cytologic findings in six cases. Cancer 1998;84:231-4 https://doi.org/10.1002/(SICI)1097-0142(19980825)84:4<231::AID-CNCR8>3.0.CO;2-P
  39. Heintz PW, Schmidt WA, Pommier RF, Vetto JT, DiTomasso JP. Submandibular gland carcinoma ex pleomorphic adenoma: report of a case with cytologic features and diagnostic pitfalls. Acta Cytol 1998;42:1431-6 https://doi.org/10.1159/000332180
  40. Taxy JB. Squamous 2000;113:21-8
  41. van der Walt JD, Leake J. Granulomatous sialadenitis of the major salivary glands. A clinicopathological study of 57 cases. Histopathology 1987;11:131-44 https://doi.org/10.1111/j.1365-2559.1987.tb02617.x
  42. Saad RS, Takei H, Lipscomb J, Ruiz B. Nodular fasciitis of parotid region: A pitfall in the diagnosis of pleomorphic adenomas on fine.needle aspiration cytology. Diagn Cytopathol 2005;33:191-4 https://doi.org/10.1002/dc.20323
  43. Abendroth CS, Frauenhoffer EE. Nodular fasciitis of the parotid gland. Report of a case with presentation in an unusual location and cytologic differential diagnosis. Acta Cytol 1995;39:530-4
  44. Kapila K, Mathur S, Verma K. Schwannomas: a pitfall in the diagnosis of pleomorphic adenomas on fine.needle aspiration cytology. Diagn Cytopathol 2002;27:53-9 https://doi.org/10.1002/dc.10121
  45. Mair S, Leiman G. Benign neurilemmoma (schwannoma) masquerading as a pleomorphic adenoma of the submandibular salivary gland. Acta Cytol 1989;33:907-10
  46. Maly B, Maly A, Doviner V, Reinhartz T, Sherman Y. Fine needle aspiration biopsy of intraparotid schwannoma. A case report. Acta Cytol 2003;47:1131-4 https://doi.org/10.1159/000326664
  47. Dodd LG, Caraway NP, Luna MA, Byers RM. Myoepithelioma of the parotid. Report of a case initially examined by fine needle aspiration biopsy. Acta Cytol 1994;38:417-21
  48. Stefansson K, Wollmann R, Jerkovic M. S-100 protein in soft.tissue tumors derived from Schwann cells and melanocytes. Am J Pathol 1982;106:261-8
  49. Sciubba JJ, Brannon RB. Myoepithelioma of salivary glands: report of 23 cases. Cancer 1982;49:562-72 https://doi.org/10.1002/1097-0142(19820201)49:3<562::AID-CNCR2820490328>3.0.CO;2-6
  50. Dardick I, Cavell S, Boivin M, et al. Salivary gland myoepithelioma variants: histological, ultrastructural, and immunocytological features. Virchows Arch A Pathol Anat Histopathol 1989;416:25-42 https://doi.org/10.1007/BF01606467
  51. Nagao T, Sugano I, Ishida Y, et al. Salivary gland malignant myoepithelioma: a clinicopathologic and immunohistochemical study of ten cases. Cancer 1998;83:1292-9 https://doi.org/10.1002/(SICI)1097-0142(19981001)83:7<1292::AID-CNCR4>3.0.CO;2-L
  52. Kumar PV, Sobhani SA, Monabati A, Hashemi SB, Eghtadari F, Hamidi SA. Myoepithelioma of the salivary glands: fine needle aspiration biopsy findings. Acta Cytol 2004;48:302-8 https://doi.org/10.1159/000326377
  53. Childers EL, Furlong MA, Fanburg.Smith JC. Hemangioma of the salivary gland: a study of ten cases of a rarely biopsied/excised lesion. Ann Diagn Pathol 2002;6:339-44 https://doi.org/10.1053/adpa.2002.36662
  54. Crissman JD, Wirman JA, Harris A. Malignant myoepithelioma of the parotid gland. Cancer 1977;40: 3042-9 https://doi.org/10.1002/1097-0142(197712)40:6<3042::AID-CNCR2820400642>3.0.CO;2-N
  55. Di Palma S, Guzzo M. Malignant myoepithelioma of salivary glands: clinicopathological features of ten cases. Virchows Arch A Pathol Anat Histopathol 1993;423:389-96 https://doi.org/10.1007/BF01607152
  56. DiPalma S, Alasio L, Pilotti S. Fine needle aspiration (FNA) appearances of malignant myoepithelioma of the parotid gland. Cytopathology 1996;7:357-65 https://doi.org/10.1111/j.1365-2303.1996.tb00315.x
  57. Kwon MY, Gu M. True malignant mixed tumor (carcinosarcoma) of parotid gland with unusual mesenchymal component: a case report and review of the literature. Arch Pathol Lab Med 2001;125:812-5
  58. Bahar M, Anavi Y, Abraham A, Ben.Bassat M. Primary malignant melanoma in the parotid gland. Oral Surg Oral Med Oral Pathol 1990;70:627-30 https://doi.org/10.1016/0030-4220(90)90412-L
  59. Nasiell K, Tani E, Skoog L. Fine needle aspiration cytology and immunocytochemistry of metastatic melanoma. Cytopathology 1991;2:137-47 https://doi.org/10.1111/j.1365-2303.1991.tb00398.x
  60. Fanburg.Smith JC, Furlong MA, Childers EL. Oral and salivary gland angiosarcoma: a clinicopathologic study of 29 cases. Mod Pathol 2003;16:263-71 https://doi.org/10.1097/01.MP.0000056986.08999.FD
  61. Boucher LD, Swanson PE, Stanley MW, Silverman JF, Raab SS, Geisinger KR. Cytology of angiosarcoma. Findings in fourteen fine.needle aspiration biopsy specimens and one pleural fluid specimen. Am J Clin Pathol 2000;114:210-9
  62. Mullick SS, Mody DR, Schwartz MR. Angiosarcoma at unusual sites. A report of two cases with aspiration cytology and diagnostic pitfalls. Acta Cytol 1997;41:839-44 https://doi.org/10.1159/000332713