Primary pleomorphic adenoma of minor salivary gland in the. 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. Mammary like secretory carcinoma of the salivary gland. Salivary gland cytopathology acgme competency checklist. Minor salivary gland lesion cytology has been studied rarely in india. This area can be site of different types of salivary tumors or metastases 1. World literature suggests parapharyngeal space lesions account for only 0. The submandibular gland should be excised in a supracapsular plane. It occurs mainly in males, it is frequently bilateral. Seroustype acini of a parotid gland with dense secretory granules histologic section of a submaxillary gland. Ent surgeons excise them if a malignancy is suspected. The value of fine needle aspiration cytology in the. The cytopathology of the salivary glands is covered in the head and neck cytopathology article. Fine needle aspiration cytology fnac is a wellestablished and widely used diagnostic tool for the.
Salivary gland tumors can begin in any of the salivary glands in your mouth, neck or throat. 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. Milan system for reporting salivary gland cytopathology. Diagnostic significance of fnac in salivary gland tumours. This article will focus on some of the new advances in salivary gland tumor pathology that have a potential for clinical impact. The major salivary glands consist of the parotid, submandibular, and sublingual glands.
Preoperative cytological diagnosis may reduce the number of unnecessary surgical removals and avoid frozen sections which are notoriously difficult. Historical survivalrates insubmandibular gland cancer are lower than those achieved in parotid or minor salivary gland malignancy. Fineneedle aspiration cytology fnac is a wellestablished technique for evaluation of salivary gland lesions, but because of the. It has a cystic, oncocytic lymphoepithelial appearance.
Mammary analog secretory carcinoma masc of salivary gland origin is a recently described tumor that harbors a characteristic balanced chromosomal translocation, 1, 5 t12. Basaloidblue salivary gland tumors modern pathology. Pdf fine needle aspiration cytology fnac of salivary. Fine needle aspiration cytology fnac is being increasingly used in the diagnosis. Head and neck cytopathology is a small part of cytopathology. 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. Salivary gland tumor fineneedle aspiration cytology. To evaluate utility of fnac in salivary gland lesions. Know the clinical features of a benign salivary gland neoplasm iii. Salivary gland tumours monographs in clinical cytology, vol.
Salivary gland tumors are rare types of tumors that begin in the salivary glands. Clinical presentation the typical presentation of salivary gland tumors is the appearance of a painless palpable. Massachusetts general hospital harvard medical school, usa marc pusztaszeri, md, geneva, switzerland esther diana rossi, md, rome, italy. The accuracy of salivary cytology is high for the diagnosis of the most common salivary gland tumors such as pleomorphic adenoma and.
Role of fnac in the preoperative diagnosis of salivary gland. Within the parotid gland 75 80% of tumours are benign. The role fineneedle aspiration fna in the diagnosis of salivary gland lesions has evolved over the years. The milan system for reporting salivary gland cytopathology. They are easily accessible for fnac fine needle aspiration cytology and risks of fistula formation or tumour implantation are low. This area is the home of many structures, all of which have the potential to produce benign and malignant tumors. Thyroid cytopathology is dealt with in the thyroid cytopathology article. Understand that most salivary gland neoplasms are benign ii. The neoplasms occurred more frequently in the parotid gland 65%, followed by submandibular gland 21. Usually parotid gland, occasionally submandibular gland. Fine needle aspiration cytology fnac of salivary gland tumours. Fine needle aspiration fna of salivary gland tumours is still the favoured initial approach as it results in good sensitivity and specificity.
An approach to the why is salivary gland pathology. Cytological spectrum of salivary gland lesions and their correlation. The diagnostic accuracy of fnac in diagnosing salivary gland tumors is depicted in table 1. Salivary gland tumours monographs in clinical cytology. Minor salivary gland tumors msgts are less common than major salivary gland tumors and account only 1520% of all salivary gland neoplasms. The possibility that a parotid tumor is malignant is 20% and increases up to 7085% in sublingual and minor salivary glands. Fine needle aspiration cytology fnac for salivary gland tumours requires expertise in interpretation.
Repeat aspiration provides further information in cases with an unclear initial cytological diagnosis. This could be particularly important for aggressive salivary gland tumors, such as salivary duct carcinoma sdc. Pdf role of fine needle aspiration cytology in salivary. Salivary gland tumors are diagnostic challenge in a clinical practice and an accurate diagnosis is essential for its adequate management. Fnac of salivary gland lesions with histopathological correlation. Frontiers cytology of primary salivary glandtype tumors. Around 50% of the tumours found in the submandibular glands are benign. Fine needle aspiration cytology of minor salivary gland. Nevertheless, rare salivary gland tumors, including rare histological variants of common tumors, limit the diagnostic accuracy of fnac 3. Most of the cases originate at intra and perioral region. Cytology of myoepithelial carcinoma of the salivary gland.
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. Salivary gland tumours most often present as painless enlarging masses. Salivary gland fineneedle aspiration fna cytology has become an accepted method of evaluating salivary gland tumors preoperatively. Diagnostic challenges in fine needle aspiration cytology. 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. Salivary gland tumors sgts are rare neoplasms accounting for 0. The minor salivary glands consist of 800 small mucussecreting glands located throughout the lining of the oral cavity. Fine needle aspiration cytology of salivary gland lesions. The two most common tumors of the parotid gland cytology. A clinical approach to diagnosis and management of atypical and suspicious lesions w. These tumours form a heterogeneous group with many different subtypes, and as a result they can be difficult to interpret even after excision. Minor salivary gland tumors msgts are less common than major salivary glands and involve only 1520% of all salivary gland tumors. Fine needle aspiration cytology fnac of salivary gland.
Still in the us, carcinomas of the major salivary glands comprise 11% of. Despite the relative rarity of these tumors, there is a wealth of literature on the diagnostic performance of fna for salivary gland tumors. Investigations such as fine needle aspiration cytology and mri scans provide some useful information, but most cases will require surgical. Still in the us, carcinomas of the major salivary glands comprise 11% of oropharyngeal neoplasms. May be seen in association with dermal cylindromas in the context of a genetic mutation. The three major salivary glands are the parotid, the. 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. Also, this study showed that fna cytology has moderate accuracy and relative diagnostic value for diagnosis of salivary gland lesions. An introduction to cytopathology is in the cytopathology article. 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.
The sublingual gland is the smallest in size, characterized mainly by mucinous glands. Pdf cytological spectrum of salivary gland lesions and their. 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. Analysis of salivary gland lesions by fnac and correlation with histopathology. Fine needle and core needle biopsy in salivary tumor diagnostic. Most of the msgts originate from palate, oral cavity and lips.
Fine needle aspiration cytology of the salivary glands. When a diagnosis is not clear despite a cellular aspirate, published work is lacking on the value of repeating the test. The cytohistologic correlation was possible in 33 cases. Diagnostic accuracy of fna cytology for diagnosis of. Fine needle and core needle biopsy in salivary tumor. 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. Most are located in the parotid glands and most are benign. Role of fnac in the preoperative diagnosis of salivary. The value of fine needle aspiration cytology in the clinical. The objective of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fnac in various salivary gland lesions in. Basaloid tumors are a common diagnostic problem in salivary gland pathology. Salivary gland tumors symptoms and causes mayo clinic. However, delineating each of these tumor types is facilitated by an algorithmic approach incorporated by tumor border.
Recognize that parotid cysts or lymphadenopathy may be the presenting symptom of hiv 3. Fineneedle aspiration biopsy of salivary gland lesions. The principal hurdle in their management lies in the difficulty in distinguishing benign from malignant tumours. Malignant sgts represent 6% of head and neck cancers and 0. The submandibular gland is more lobulated with mixed glandular structure. Little is known about the total incidence of salivary gland tumours as most benign tumours go unrecorded in national cancer registries. Portion of a parotid gland demonstrating multiple foci of sebaceous differentiation.
Investigations such as fine needle aspiration cytology and mri scans provide some useful information, but most cases will require surgical excision as. Of these, the spindle cell type is most common subtype, and the plasmacytoid variant is rare, which complicates preoperative aspiration cytologybased diagnosis. Most of salivary gland tumors are benign, and the larger the gland, the more likely the tumor is benign. A wide dissection of local tissues is not required. Frontiers cytology of primary salivary glandtype tumors of. To elucidate the cytomorphological features of various salivary gland lesions and explore the diagnostic accuracy and pitfalls of fnac. Pdf cytopathological study of salivary gland lesions by fine.
Limitations because of complex and varied histology of salivary tumours, fnac has limited accuracy, even in expert hands benign vs malignant. 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. Salivary gland tumors are rare in pediatric patients and include both benign and malignant types. Diagnostic accuracy of fna cytology for diagnosis of salivary. Anatomy and cytology of salivary glands eurocytology. The salivary glands are classified as major or minor. 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. Conclusion the primary role of fnac in salivary gland tumors is to offer a morphological diagnosis whenever that is possible.
Salivary gland tumours or neoplasms are tumours that form in the tissues of salivary glands. The rates of false negative diagnoses made on cytology, which have been reported in the literature, range from 0 to 37% 5, 15, 16. Diagnostic histopathology of tumors 4th ed elsevier 20 the microscopic approach 1. Salivary glands, fine needle aspiration cytology, milan system for reporting salivary gland cytology, risk of neoplasm, risk of. Newly described salivary gland tumors modern pathology. The aspirated material is usually brown, dirty and thick. They are easily accessible for fnac fine needle aspiration cytology and risks of fistula formation or tumour implantation are low compared surgical biopsy. Risk assessment of salivary gland cytological categories of the. Fine needle aspiration cytology fnac is being increasingly used in the diagnosis of salivary lesions. Diagnostic significance of fnac in salivary gland tumours a. Fnac of salivary gland lesions with histopathological. The parapharyngeal space is very rare site for this tumour.
Sep 20, 2014 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. 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 of minor salivary gland tumours of the palate. Reliability of fine needle aspiration cytology for salivary gland.
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