Salivary Gland Cytology case of adenoid cyst carcinoma
Cases:12 FNA- 7ParotidPreparation –2 pap QDClinical: male , 52 years. Parotic swelling ,Screened and reported by: Sejojo Phaaroe. M.T; C.T (I.A.C); M.I.B.M.SCytology:This is a sanguineous and a mucinous back grounded smear with some cells in glandular groups, 3dimensional syncytia, and rosettes configurations are present. There is marked cellularpleomorphism , anisonucleosis, nuclear noses, pulled out tad poled and indentations. Cells exhibitsalt and pepper coarse chromatin granulation - slide 5682 ( red and green colour)5684Cell syncytia, cell pleomorphism, noses, and macro-nucleation seen.Bi- Nucleation , , mitotic figures with promonent nucleoli seen .5658Mixed mesenchymal cells with pulled out cells, some cells are single lying, the size of the single lyinglymphocyte.Diagnosis: Adenoid cystic carcinomaFinal diagnosis: Malignant:Screened by: Sejojo Phaaroe. MT; CT (IAC); MIBMS
DiscussionsThe major salivary glands are the parotid glands, submandibular glands and sublingualglands. There are also a large number (600-1,000) of minor salivary glands widely distributedthroughout the oral mucosa, palate, uvula, floor of the mouth, posterior tongue, retromolarand peritonsillar area, pharynx, larynx and paranasal sinuses. Tumours affecting salivaryglands may be benign or malignant and are diverse in their pathology. 80% of salivary gland neoplasms arise in the parotid glands, 10-15% in the submandibular glands and the remainder in the sublingual and minor salivary glands.1 About 80% of parotid neoplasms are benign but the relative proportion of malignancy increases in smaller glands. About half of submandibular gland neoplasms and most sublingual and minor salivary gland tumours are malignant.ClassificationMalignant tumoursThe malignant tumours most commonly affecting the major salivary glands aremucoepidermoid carcinoma, acinic cell carcinoma and adenoid cystic carcinomas. Amongthe minor salivary glands, adenoid cystic carcinoma is the most common. Malignant tumoursare designated high-grade or low-grade dependent on their histology. High-grade: o Mucoepidermoid carcinoma (grade III): mucoepidermoid carcinoma is the most common malignancy of the parotid gland and is the second most common of the submandibular gland (after adenoid cystic carcinoma). It represents about 8% of all parotid tumours. o Adenocarcinoma - poorly differentiated carcinoma and anaplastic carcinoma; represents 2-3% of salivary tumours. o Squamous cell carcinoma. o Malignant mixed tumours. o Adenoid cystic carcinoma. Low-grade: o Acinic cell tumours: represent 1% of all salivary gland neoplasms. 95% arise in the parotid gland. o Mucoepidermoid carcinoma (grades I or II).Benign tumours Pleomorphic adenoma (most common): also called benign mixed tumour, is the most common tumour of the parotid gland and causes over a third of submandibular tumours. They are slow-growing and asymptomatic. Warthins tumour: second most common benign salivary gland neoplasm, representing about 6-10% of all parotid tumours. They rarely occur in other glands and 12% are bilateral. They present most often in the 6th decade in women and the 7th decade in men.2 Rarities including oncocytomas and monomorphic adenomas.
Regional metastases from skin or mucosal malignancies may present as salivary glandmasses. 1-3% of patients with cutaneous squamous cell carcinoma of the head and neckexperience metastatic spread to the parotid-area lymph nodes. Lymphomas may occasionallypresent in a salivary gland.3 In children, most parotid tumours are benign and arehaemangiomas.4Epidemiology1 Neoplasms of salivary glands have an incidence of about 1 to 2 per 100,000 per annum in England and Wales, with about 470 new cases diagnosed every year.5 They are fewer than 1% of all cancers and 3-6% of all tumours of the head and neck. Tumours are most common in the 6th decade of life. Malignancy typically presents after age 60, whilst benign lesions usually occur after age 40. Benign tumours are more common in women, but malignant tumours have an equal sex distribution. Certain ethnic groups, e.g. Inuit populations, have a higher rate of salivary gland tumours which is maintained even after migration to a low incidence area. The responsible environmental or genetic factors are unknown.6Risk factors Radiation to the neck increases the risk of malignancy of salivary glands with a 15- to 20-year latency.7 Smoking is an important risk factor for the development of Warthins tumours but its relationship to malignant parotid tumours is less clear.8 Warthins tumours are eight times more common in smokers compared with non-smokers. Some studies have suggested an association between high use of mobile phones and an increased risk of benign and malignant parotid tumours9, although others have found no evidence of such a relationship.10Presentation1In England and Wales, about 13% patients with salivary gland cancer present with earlydisease, 17% with locally advanced, 7% with lymph node involvement and 28% withmetastatic disease (and unknown staging in 35%).5Symptoms Most salivary gland neoplasms are a slowly enlarging painless mass: o Parotid neoplasms most commonly occur in the tail of the gland as a discrete mass in an otherwise normal gland. o Submandibular neoplasms often appear with diffuse enlargement of the gland. o Sublingual tumours produce a palpable fullness in the floor of the mouth. o Minor salivary gland tumours vary according on the site of origin - painless masses on the palate or floor of the mouth are the most common form but laryngeal salivary gland tumours can produce airway obstruction, dysphagia,
or hoarseness. In the nasal cavity or paranasal sinus they cause nasal obstruction or sinusitis. Facial palsy with a salivary gland mass indicates malignancy. Pain can occur with both benign and malignant tumours. Pain may arise from suppuration or haemorrhage into a mass or from infiltration of adjacent tissue.SignsUse bimanual palpation of the lateral pharyngeal wall for deep lobe parotid tumours and theextent of submandibular and sublingual masses. Clinical features of a salivary gland mass suggestive of malignancy are: o Hardness. o Fixation. o Tenderness. o Infiltration of surrounding structures, e.g. facial nerve, local lymph nodes. o Overlying skin ulceration. Cranial nerve palsy