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