This area can be site of different types of salivary tumors or metastases 1. Most of salivary gland tumors are benign, and the larger the gland, the more likely the tumor is benign. Conclusion the primary role of fnac in salivary gland tumors is to offer a morphological diagnosis whenever that is possible. Pdf cytopathological study of salivary gland lesions by fine. Reliability of fine needle aspiration cytology for salivary gland. The cytopathology of the salivary glands is covered in the head and neck cytopathology article. The three major salivary glands are the parotid, the. Mecs can occur at any age, they can involve both the major and minor salivary glands, and they are the most common malignant salivary gland tumours which are seen in children.
The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. The salivary glands are classified as major or minor. A wide dissection of local tissues is not required. This article will focus on some of the new advances in salivary gland tumor pathology that have a potential for clinical impact. Still in the us, carcinomas of the major salivary glands comprise 11% of. Fine needle aspiration cytology of the salivary glands. Pdf role of fine needle aspiration cytology in salivary. Pleomorphic adenoma pleomorphic adenoma is by far the most common salivary gland tumors comprising 50%60% of all salivary gland neoplasm and approximately 60%80% of parotid gland neoplasm pap40x combination of myoepithelial cells. The submandibular gland should be excised in a supracapsular plane. Cytological spectrum of salivary gland lesions and their correlation.
Salivary gland tumors symptoms and causes mayo clinic. They are easily accessible for fnac fine needle aspiration cytology and risks of fistula formation or tumour implantation are low compared surgical biopsy. Diagnostic accuracy of fna cytology for diagnosis of salivary. Primary pleomorphic adenoma of minor salivary gland in the. Fine needle and core needle biopsy in salivary tumor diagnostic. Recognize that parotid cysts or lymphadenopathy may be the presenting symptom of hiv 3. Within the parotid gland 75 80% of tumours are benign. Role of fnac in the preoperative diagnosis of salivary. Understand that most salivary gland neoplasms are benign ii. This could be particularly important for aggressive salivary gland tumors, such as salivary duct carcinoma sdc. Nevertheless, rare salivary gland tumors, including rare histological variants of common tumors, limit the diagnostic accuracy of fnac 3. Salivary gland tumors are rare types of tumors that begin in the salivary glands. Diagnostic significance of fnac in salivary gland tumours a. The neoplasms occurred more frequently in the parotid gland 65%, followed by submandibular gland 21.
Know the clinical features of a benign salivary gland neoplasm iii. Most of the msgts originate from palate, oral cavity and lips. An introduction to cytopathology is in the cytopathology article salivary gland cytopathology and salivary gland cytology redirect to here. Head and neck cytopathology is a small part of cytopathology.
It occurs mainly in males, it is frequently bilateral. The possibility that a parotid tumor is malignant is 20% and increases up to 7085% in sublingual and minor salivary glands. Risk assessment of salivary gland cytological categories of the. Salivary gland tumors can begin in any of the salivary glands in your mouth, neck or throat. Ent surgeons excise them if a malignancy is suspected. Around 50% of the tumours found in the submandibular glands are benign. Salivary gland cytology is an exciting branch of cytology that over the years has matured for the development of its own unified system for reporting, the milan classification 25. The major salivary glands consist of the parotid, submandibular, and sublingual glands. Salivary gland cytopathology improve communication between pathologists and clinicians improve patient care facilitate cytologichistologic correlation facilitate research into the epidemiology, molecular biology, pathology, and diagnosis of salivary gland diseases facilitate sharing of data from different laboratories for. Massachusetts general hospital harvard medical school, usa marc pusztaszeri, md, geneva, switzerland esther diana rossi, md, rome, italy. An introduction to cytopathology is in the cytopathology article.
The cytological features of the various tumors of the salivary gland have overlapping cytological features and many other lesions in the head neck region may mimic salivary lesions. Frontiers cytology of primary salivary glandtype tumors. The aspirated material is usually brown, dirty and thick. Mammary analog secretory carcinoma masc of salivary gland origin is a recently described tumor that harbors a characteristic balanced chromosomal translocation, 1, 5 t12. Diagnostic histopathology of tumors 4th ed elsevier 20 the microscopic approach 1. Salivary gland tumor fineneedle aspiration cytology. Milan system for reporting salivary gland cytopathology.
May be seen in association with dermal cylindromas in the context of a genetic mutation. This area is the home of many structures, all of which have the potential to produce benign and malignant tumors. Pdf cytological spectrum of salivary gland lesions and their. Fnac of salivary gland lesions with histopathological correlation. Fine needle aspiration cytology fnac is being increasingly used in the diagnosis of salivary lesions. World literature suggests parapharyngeal space lesions account for only 0. Primary salivary glandtype tumors psgt arising from the seromucinous submucosal glands of the lower respiratory tract lrt which includes trachea, bronchus and lung account for. Fine needle aspiration cytology of minor salivary gland. Minor salivary gland tumors msgts are less common than major salivary glands and involve only 1520% of all salivary gland tumors. Mammary like secretory carcinoma of the salivary gland. The value of fine needle aspiration cytology in the clinical. Clinical studies have shown that aspiration cytology of salivary gland tumors has a sensitivity between 60100% and a specificity between 90100% in the diagnosis of these lesions 4. Anatomy and cytology of salivary glands eurocytology. The cytohistologic correlation was possible in 33 cases.
Minor salivary gland tumors msgts are less common than major salivary gland tumors and account only 1520% of all salivary gland neoplasms. To evaluate utility of fnac in salivary gland lesions. Investigations such as fine needle aspiration cytology and mri scans provide some useful information, but most cases will require surgical. Role of fnac in the preoperative diagnosis of salivary gland. These tumours form a heterogeneous group with many different subtypes, and as a result they can be difficult to interpret even after excision. Fine needle aspiration cytology fnac for salivary gland tumours requires expertise in interpretation. The role fineneedle aspiration fna in the diagnosis of salivary gland lesions has evolved over the years. Portion of a parotid gland demonstrating multiple foci of sebaceous differentiation. Fineneedle aspiration biopsy of salivary gland lesions. Pdf fine needle aspiration cytology fnac of salivary.
They are easily accessible for fnac fine needle aspiration cytology and risks of fistula formation or tumour implantation are low. Fine needle aspiration cytology of salivary gland lesions. Despite the relative rarity of these tumors, there is a wealth of literature on the diagnostic performance of fna for salivary gland tumors. Repeat aspiration provides further information in cases with an unclear initial cytological diagnosis. The parapharyngeal space is very rare site for this tumour. The minor salivary glands consist of 800 small mucussecreting glands located throughout the lining of the oral cavity. The diagnostic accuracy of fnac in diagnosing salivary gland tumors is depicted in table 1.
The two most common tumors of the parotid gland cytology. The rates of false negative diagnoses made on cytology, which have been reported in the literature, range from 0 to 37% 5, 15, 16. Salivary gland tumours most often present as painless enlarging masses. The sublingual gland is the smallest in size, characterized mainly by mucinous glands. The objective of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fnac in various salivary gland lesions in. Thyroid cytopathology is dealt with in the thyroid cytopathology article. Pleomorphic adenoma pleomorphic adenoma is by far the most common salivary gland tumors comprising 50%60% of all salivary gland neoplasm and approximately 60%80% of parotid gland neoplasm pap40x combination of myoepithelial cells and mixoid matrix pap100x myoepithelial. The value of fine needle aspiration cytology in the. Still in the us, carcinomas of the major salivary glands comprise 11% of oropharyngeal neoplasms. Salivary gland fineneedle aspiration fna cytology has become an accepted method of evaluating salivary gland tumors preoperatively. Salivary glands, fine needle aspiration cytology, milan system for reporting salivary gland cytology, risk of neoplasm, risk of. Fine needle aspiration cytology fnac of salivary gland tumours. Most of the cases originate at intra and perioral region.
Basaloid tumors are a common diagnostic problem in salivary gland pathology. Of these, the spindle cell type is most common subtype, and the plasmacytoid variant is rare, which complicates preoperative aspiration cytologybased diagnosis. Basaloidblue salivary gland tumors modern pathology. An approach to the why is salivary gland pathology. Salivary glands make saliva, which aids in digestion, keeps your mouth moist and supports healthy teeth. However, delineating each of these tumor types is facilitated by an algorithmic approach incorporated by tumor border.
Fine needle aspiration cytology of minor salivary gland tumours of the palate. When a diagnosis is not clear despite a cellular aspirate, published work is lacking on the value of repeating the test. Historical survivalrates insubmandibular gland cancer are lower than those achieved in parotid or minor salivary gland malignancy. Salivary gland tumors are rare in pediatric patients and include both benign and malignant types. Newly described salivary gland tumors modern pathology. The cytopathology of salivary glands presents major challenges due to the heterogeneity of benign and malignant neoplasms, which is reflected in the large range of who 2017 classifications. Salivary gland tumors sgts are rare neoplasms accounting for 0.
Diagnostic accuracy of fna cytology for diagnosis of. Analysis of salivary gland lesions by fnac and correlation with histopathology. Fineneedle aspiration cytology fnac is a wellestablished technique for evaluation of salivary gland lesions, but because of the. Fnac of salivary gland lesions with histopathological. Seroustype acini of a parotid gland with dense secretory granules histologic section of a submaxillary gland. Limitations because of complex and varied histology of salivary tumours, fnac has limited accuracy, even in expert hands benign vs malignant. Guidelines for the practical clinical application of aspiration cytology related to salivary gland tumors as well as the accuracy of cytological diagnosis and a complete bibliography are presented. Diagnostic challenges in fine needle aspiration cytology. Salivary gland cytopathology acgme competency checklist. Little is known about the total incidence of salivary gland tumours as most benign tumours go unrecorded in national cancer registries. Minor salivary gland lesion cytology has been studied rarely in india. Zbaren et al3 have noted accuracy, sensitivity, and speci. The submandibular gland is more lobulated with mixed glandular structure.
Malignant sgts represent 6% of head and neck cancers and 0. The accuracy of salivary cytology is high for the diagnosis of the most common salivary gland tumors such as pleomorphic adenoma and. To elucidate the cytomorphological features of various salivary gland lesions and explore the diagnostic accuracy and pitfalls of fnac. Preoperative cytological diagnosis may reduce the number of unnecessary surgical removals and avoid frozen sections which are notoriously difficult. Usually parotid gland, occasionally submandibular gland. Salivary gland tumours or neoplasms are tumours that form in the tissues of salivary glands.
Fine needle aspiration cytology fnac is a wellestablished and widely used diagnostic tool for the. Diagnostic significance of fnac in salivary gland tumours. Most are located in the parotid glands and most are benign. Cytology of myoepithelial carcinoma of the salivary gland. A clinical approach to diagnosis and management of atypical and suspicious lesions w. Of these, the spindle cell type is most common subtype, and the plasmacytoid variant is rare, which complicates preoperative aspiration cytology based diagnosis. Moreover, at times it may be difficult to differentiate benign from malignant tumor of the tumor with same cell of origin. Fine needle aspiration cytology fnac is being increasingly used in the diagnosis. The milan system for reporting salivary gland cytopathology.
Clinical presentation the typical presentation of salivary gland tumors is the appearance of a painless palpable. It has a cystic, oncocytic lymphoepithelial appearance. Also, this study showed that fna cytology has moderate accuracy and relative diagnostic value for diagnosis of salivary gland lesions. The accuracy of salivary cytology is high for the diagnosis of the most common salivary gland tumors such as pleomorphic adenoma and warthin tumor, but the specificity for subtyping a particular neoplasm shows a wide range 48 to 94 percent depending on tumor type. Fine needle and core needle biopsy in salivary tumor.
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