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Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland

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Abstract

Fine needle aspiration (FNA) has diagnostic and therapeutic value in the management of salivary gland cysts. Rendering an accurate diagnosis from an aspirated salivary gland cyst is challenging because of the broad differential diagnosis, possibility of sampling error, frequent hypocellularity of specimens, morphologic heterogeneity, and overlapping cytomorphology of many cystic entities. To date, there have been no comprehensive review articles providing a practical diagnostic approach to FNA of cystic lesions of salivary glands. This article reviews the cytopathology of salivary gland cysts employing 2017 World Health Organization terminology, addresses the accuracy of FNA, and presents The Milan System approach for reporting in cystic salivary gland cases. The utility of separating FNA specimens from salivary gland cysts, based upon the presence of mucin and admixed lymphocytes in cyst fluid is demonstrated. A reliable approach to interpreting FNA specimens from patients with cystic salivary gland lesions is essential to accurately determine which of these patients may require subsequent surgery.

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References

  1. Takita H, Takeshita T, Shimono T, Tanaka H, Iguchi H, Hashimoto S, Kuwae Y, Ohsawa M, Miki Y. Cystic lesions of the parotid gland: radiologic-pathologic correlation according to the latest World Health Organization 2017 Classification of Head and Neck Tumours. Jpn J Radiol. 2017;35:629–47.

    Article  CAS  Google Scholar 

  2. Ellis GL, Auclair PL. Tumors of the salivary glands. Washington DC: ARP Press; 2008.

    Google Scholar 

  3. Pusztaszeri M, Baloch Z, Faquin WC, Rossi ED, Tabatabai ZL. Atypia of undetermined significance. In: Faquin WC, Rossi ED, editors. The Milan system for reporting salivary gland cytopathology. Cham: Springer; 2018. pp. 43–54.

    Google Scholar 

  4. Wenig BM. Atlas of head and neck pathology. 3rd ed. Philadelphia: Elsevier; 2016.

    Google Scholar 

  5. Hegde PN, Prasad HLK, Kumar YS, Sajitha K, Roy PS, Raju M, Shetty V. A rare case of an epidermoid cyst in the parotid gland: which was diagnosed by fine needle aspiration cytology. J Clin Diagn Res. 2013;7:550–2.

    Google Scholar 

  6. Wang W, Li Y, Tang Y. Keratocystoma of the parotid gland: a case report and review of previous publications. Br J Oral Maxillofac Surg. 2015;53:655–7.

    Article  Google Scholar 

  7. Righi PD, Wells WA, Wagner JD, Kim SA, Anderson MW, Longardner NR. Odontogenic keratocyst of the mandible: an unusual cause of a parotid mass. Ann Plast Surg. 1998;41:89–93.

    Article  CAS  Google Scholar 

  8. Arora VK, Chopra N, Singh P, Venugopal VK, Narang S. Hydatid cyst of parotid: report of unusual cytological findings extending the cytomorphological spectrum. Diagn Cytopathol. 2016;44:770–3.

    Article  Google Scholar 

  9. Białek EW, Jakubowski W. Mistakes in ultrasound examination of salivary glands. J Ultrasonography. 2016;16:191–203.

    Article  Google Scholar 

  10. Layfield L. Cytopathology of the head and neck. Chicago: ASCP Press; 1997.

    Google Scholar 

  11. Firat P, Ersoz C, Uguz A, Onder S. Cystic lesions of the head and neck: cytohistological correlation in 63 cases. Cytopathology 2007;18:184–90.

    CAS  Google Scholar 

  12. Chen KT. Diagnostic pitfalls in fine needle aspiration of cystic salivary gland lesions. Acta Cytol. 2007;51:675–6.

    Google Scholar 

  13. Kim MW, Kim DW, Jung HS, Choo HJ, Park YM, Jung SJ, Baek HJ. Factors influencing the outcome of ultrasound-guided fine-needle aspiration for salivary gland lesion diagnosis. J Ultrasound Med. 2016;35:877–83.

    Article  Google Scholar 

  14. Stewart CJ, MacKenzie K, McGarry GW, Mowat A. Fine-needle aspiration cytology of salivary gland: a review of 341 cases. Diagn Cytopathol. 2000;22:139–46.

    Article  CAS  Google Scholar 

  15. Layfield LJ, Gopez EV. Cystic lesions of the salivary glands: cytologic features in fine-needle aspiration biopsies. Diagn Cytopathol. 2002;27:197–204.

    Article  Google Scholar 

  16. Edwards PC, Wasserman P. Evaluation of cystic salivary gland lesions by fine needle aspiration: an analysis of 21 cases. Acta Cytol. 2005;49:489–94.

    Article  Google Scholar 

  17. Allison DB, Mc Cuiston AM, Kawamoto S, Eisele DW, Bishop JA, Maleki Z. Cystic salivary gland lesions: utilizing fine needle aspiration to optimize the clinical management of a broad and diverse differential diagnoses. Diagn Cytopathol. 2017;45:800–7.

    Article  Google Scholar 

  18. Madrigal E, Chhieng D, Harshan M. Cytologic-histologic correlation of cystic non-mucinous and mucinous salivary gland lesions. J of Am Soc Cytopathol. 2017;6:S82.

    Article  Google Scholar 

  19. Baloch Z, Field AS, Katabi N, Wenig BM. The Milan system for reporting salivary gland cytopathology. In: Faquin WC, Rossi ED, editors. The Milan system for reporting salivary gland cytopathology. Cham: Springer; 2018. pp. 1–9.

    Google Scholar 

  20. Moatamed NA, Naini BV, Fathizadeh P, Estrella J, Apple SK. A correlation study of diagnostic fine-needle aspiration with histologic diagnosis in cystic neck lesions. Diagn Cytopathol. 2009;37:720–6.

    Article  Google Scholar 

  21. Bajwa MS, Nicolai P, Varvares MA. Clinical management. In: Faquin WC, Rossi ED, editors. The Milan system for reporting salivary gland cytopathology. Cham: Springer; 2018. pp. 157–68.

    Google Scholar 

  22. Faquin WC, Powers CN. Cystic and mucinous lesions: mucocele and low-grade mucoepidermoid carcinoma. In: Faquin WC, Powers CN, editors. Salivary gland cytopathology. Boston: Springer; 2008. p. 159181.

    Chapter  Google Scholar 

  23. Stojanov IJ, Malik UA, Woo SB. Intraoral salivary duct cyst: clinical and histopathologic features of 177 cases. Head Neck Pathol. 2017;11:469–76.

    Article  Google Scholar 

  24. de Brito Monteiro BV, Bezerra TM, da Silveira ÉJ, Nonaka CF, da Costa Miguel MC. Histopathological review of 667 cases of oral mucoceles with emphasis on uncommon histopathological variations. Ann Diagn Pathol. 2016;21:44–6.

    Article  Google Scholar 

  25. Khalbuss WE, Monaco SE, Pantanowitz L. Quick compendium of cytopathology. Chicago: ASCP Press. 2013.

    Google Scholar 

  26. Gong X, Xiong P, Liu S, Xu Q, Chen Y. Ultrasonographic appearances of mucoepidermoid carcinoma of the salivary glands. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:382–7.

    Article  Google Scholar 

  27. Elsheikh TM, Chute DJ. Tumors of the salivary glands: benign and low-grade malignancies. In: Baloch ZW, Elsheikh TM, Faquin WC, Vielh P, editors. Head and neck cytohistology. Cambridge: Cambridge University Press; 2014. pp. 76–109.

    Google Scholar 

  28. Joseph TP, Joseph CP, Jayalakshmy PS, Poothiode U. Diagnostic challenges in cytology of mucoepidermoid carcinoma: report of 6 cases with histopathological correlation. J Cytol. 2015;32:21–4.

    Article  Google Scholar 

  29. Wade TV, Livolsi VA, Montone KT, Baloch ZW. A correlation of mucoepidermoid carcinoma: emphasizing the rare oncocytic variant. Patholog Res Int. 2011;2011:135796.

    Google Scholar 

  30. Hang JF, Shum CH, Ali SZ, Bishop JA. Cytological features of the Warthin-like variant of salivary mucoepidermoid carcinoma. Diagn Cytopathol. 2017;45:1132–6.

    Article  Google Scholar 

  31. Williamson JD, Simmons BH, el-Naggar A, Medeiros LJ. Mucoepidermoid carcinoma involving Warthin tumor. A report of five cases and review of the literature. Am J Clin Pathol. 2000;114:564–70.

    Article  CAS  Google Scholar 

  32. Chin S, Kim HK, Kwak JJ. Oncocytic papillary cystadenoma of major salivary glands: three rare cases with diverse cytologic features. J Cytol. 2014;31:221–3.

    Article  Google Scholar 

  33. Budnick S, Simpson RHW. Cystadenoma. In: El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ, editors. WHO classification of head and neck tumors. Lyon: International Agency for Research on Cancer; 2017. p. 191.

    Google Scholar 

  34. Başak K, Kiroğlu K. Multiple oncocytic cystadenoma with intraluminal crystalloids in parotid gland: case report. Medicine (Baltimore). 2014;93:e246.

    Article  Google Scholar 

  35. Kawahara A, Harada H, Mihashi H, Akiba J, Kage M. Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: diagnostic pitfalls and literature review. Diagn Cytopathol. 2010;38:377–81.

    Google Scholar 

  36. Khatib Y, Dande M, Patel RD, Kane SV. Cytomorphological findings and histological correlation of papillary cystadenocarcinoma of the parotid: not always a low-grade tumor. Indian J Pathol Microbiol. 2016;59:368–71.

    Article  Google Scholar 

  37. Schneller J, Solomon M, Webber CA, Nasim M. Mucinous cystadenocarcinoma of the parotid gland: report of a case with fine needle aspiration findings and histologic correlation. Acta Cytol. 2001;45:605–9.

    Article  CAS  Google Scholar 

  38. Bernier JL, Bhaskar SN. Lymphoepithelial lesions of salivary glands; histogenesis and classification based on 186 cases. Cancer 1958;11:1156–79.

    Article  CAS  Google Scholar 

  39. Upile T, Jerjes W, Al-Khawalde M, Kafas P, Frampton S, Gray A, Addis B, Sandison A, Patel N, Sudhoff H, Radhi H. Branchial cysts within the parotid salivary gland. Head Neck Oncol. 2012;4:24.

    Article  Google Scholar 

  40. Michelow P, Dezube BJ, Pantanowitz L. Fine needle aspiration of salivary gland masses in HIV-infected patients. Diagn Cytopathol. 2012;40:684–90.

    Article  Google Scholar 

  41. Ahamed AS, Kannan VS, Velaven K, Sathyanarayanan GR, Roshni J, Elavarasi E. Lymphoepithelial cyst of the submandibular gland. J Pharm Bioallied Sci. 2014;6(Suppl 1):S185–7.

    Article  Google Scholar 

  42. Gadodia A, Seith A, Sharma R. Unusual presentation of Sjögren syndrome: multiple parotid cysts. Ear Nose Throat J. 2012;91:E17–9.

    Google Scholar 

  43. Wu L, Cheng J, Maruyama S, Yamazaki M, Tsuneki M, Lu Y, He Z, Zheng Y, Zhou Z, Saku T. Lymphoepithelial cyst of the parotid gland: its possible histopathogenesis based on clinicopathologic analysis of 64 cases. Hum Pathol. 2009;40:683–92.

    Article  Google Scholar 

  44. Gupta N, Gupta R, Rajwanshi A, Bakshi J. Multinucleated giant cells in HIV-associated benign lymphoepithelial cyst-like lesions of the parotid gland on FNAC. Diagn Cytopathol. 2009;37:203–4.

    Article  Google Scholar 

  45. Iwai T, Baba J, Murata S, Mitsudo K, Maegawa J, Nagahama K, Tohnai I. Warthin tumor arising from the minor salivary gland. J Craniofac Surg. 2012;23:e374–6.

    Article  Google Scholar 

  46. Patel DK, Morton RP. Demographics of benign parotid tumours: Warthin’s tumour versus other benign salivary tumours. Acta Otolaryngol. 2016;136:83–6.

    Article  Google Scholar 

  47. Sagiv D, Witt RL, Glikson E, Mansour J, Shalmon B, Yakirevitch A, Wolf M, Alon EE, Slonimsky G, Talmi YP. Warthin tumor within the superficial lobe of the parotid gland: a suggested criterion for diagnosis. Eur Arch Otorhinolaryngol. 2017;274:1993–6.

    Article  Google Scholar 

  48. Medeiros LJ, Rizzi R, Lardelli P, Jaffe ES. Malignant lymphoma involving a Warthin’s tumor: a case with immunophenotypic and gene rearrangement analysis. Hum Pathol. 1990;21:974–7.

    Article  CAS  Google Scholar 

  49. Ballo MS, Shin HJ, Sneige N. Sources of diagnostic error in the fine-needle aspiration diagnosis of Warthin’s tumor and clues to a correct diagnosis. Diagn Cytopathol. 1997;17:230–4.

    Article  CAS  Google Scholar 

  50. Parwani AV, Ali SZ. Diagnostic accuracy and pitfalls in fine-needle aspiration interpretation of Warthin tumor. Cancer 2003;99:166–71.

    Article  Google Scholar 

  51. Viguer JM, Vicandi B, Jiménez-Heffernan JA, López-Ferrer P, González-Peramato P, Castillo C. Role of fine needle aspiration cytology in the diagnosis and management of Warthin’s tumour of the salivary glands. Cytopathology 2010;21:164–9.

    Article  CAS  Google Scholar 

  52. Seifert G, Thomsen S, Donath K. Bilateral dysgenetic polycystic parotid glands. Morphological analysis and differential diagnosis of a rare disease of the salivary glands. Virchows Arch A. 1981;390:273–88.

    Article  CAS  Google Scholar 

  53. Kumar KA, Mahadesh J, Setty S. Dysgenetic polycystic disease of the parotid gland: report of a case and review of the literature. J Oral Maxillofac Pathol. 2013;17:248–52.

    Article  Google Scholar 

  54. Koudounarakis E, Willems S, Karakullukcu B. Dysgenetic polycystic disease of the minor and submandibular salivary glands. Head Neck. 2016;38:E2437–9.

    Article  Google Scholar 

  55. Layfield LJ, Gopez EV. Histologic and fine-needle aspiration cytologic features of polycystic disease of the parotid glands: case report and review of the literature. Diagn Cytopathol. 2002;26:324–8.

    Article  Google Scholar 

  56. Granter SR, Renshaw AA, Cibas ES. Nontyrosine crystalloids in fine-needle aspiration specimens of the parotid gland: a report of two cases and review of the literature. Diagn Cytopathol. 1999;20:44–6.

    Article  CAS  Google Scholar 

  57. Nasuti JF, Gupta PK, Fleisher SR, LiVolsi VA. Nontyrosine crystalloids in salivary gland lesions: report of seven cases with fine-needle aspiration cytology and follow-up surgical pathology. Diagn Cytopathol. 2000;22:167–71.

    Article  CAS  Google Scholar 

  58. Pantanowitz L, Goulart RA, Cao QJ. Salivary gland crystalloids. Diagn Cytopathol. 2006;34:749–50.

    Article  Google Scholar 

  59. Kuwabara H, Ishizaki S, Akashi S, Yuki M, Shibayama Y. α-Amylase crystalloid granuloma in the parotid gland. Diagn Cytopathol. 2015;43:114–6.

    Article  Google Scholar 

  60. Gould AR, Van Arsdall LR, Hinkle SJ, Harris WR. Tyrosine-rich crystalloids in adenoid cystic carcinoma: histochemical and ultrastructural observations. J Oral Pathol. 1983;12:478–90.

    Article  CAS  Google Scholar 

  61. Raubenheimer EJ, van Heerden WF, Thein T. Tyrosine-rich crystalloids in a polymorphous low-grade adenocarcinoma. Oral Surg Oral Med Oral Pathol. 1990;70:480–2.

    Article  CAS  Google Scholar 

  62. Lemos LB, Baliga M, Brister T, Cason Z. Cytomorphology of tyrosine-rich crystalloids in fine needle aspirates of salivary gland adenomas. Acta Cytol. 1997;41:1709–13.

    Article  CAS  Google Scholar 

  63. Takeda Y. Crystalloid granuloma of the parotid gland: a previously undescribed salivary gland lesion. J Oral Pathol Med. 1991;20:234–6.

    Article  CAS  Google Scholar 

  64. Horie Y, Ikawa S, Ishizu Y. Crystalloid granuloma of the parotid gland: a case report. Pathol Int. 1994;44:535–9.

    Article  CAS  Google Scholar 

  65. Yada N, Kashima K, Daa T, Urabe S, Kondo Y, Yokoyama S. α-Amylase crystalloid granuloma of the parotid gland: case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114:e43–8.

    Article  Google Scholar 

  66. Ho C, Sasaki CT, Prasad ML. Crystalloid granulomas of the parotid gland mimicking tumor: a case report with review of the literature. Int J Surg Pathol. 2013;21:282–6.

    Article  Google Scholar 

  67. Srivastava S, Chougule A, Gupta N, Srinivasan R. Crystalloid granuloma with amylase crystalloids in submandibular gland cytology. Diagn Cytopathol. 2016;44:66–7.

    Article  Google Scholar 

  68. Skalova A, Bell D, Bishop JA, Inagaki H, Seethala R, Vielh P. Secretory carcinoma. In: El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ, editors. WHO classification of head and neck tumors. Lyon: International Agency for Research on Cancer; 2017. pp. 177–8.

    Google Scholar 

  69. Bishop JA, Yonescu R, Batista DA, Westra WH, Ali SZ. Cytopathologic features of mammary analogue secretory carcinoma. Cancer Cytopathol. 2013;121:228–33.

    Article  CAS  Google Scholar 

  70. Samulski TD, LiVolsi VA, Baloch Z. The cytopathologic features of mammary analog secretory carcinoma and its mimics. Cytojournal 2014;11:24.

    Article  Google Scholar 

  71. Griffith CC, Stelow EB, Saqi A, Khalbuss WE, Schneider F, Chiosea SI, Seethala RR. The cytological features of mammary analogue secretory carcinoma: a series of 6 molecularly confirmed cases. Cancer Cytopathol. 2013;121:234–41.

    Article  CAS  Google Scholar 

  72. Kai K, Minesaki A, Suzuki K, Monji M, Nakamura M, Tsugitomi H, Kuratomi Y, Aishima S. Difficulty in the cytodiagnosis of mammary analogue secretory carcinoma: survey of 109 cytologists with a case originating from a minor salivary gland. Acta Cytol. 2017;61:469–76.

    Article  Google Scholar 

  73. Gonzalez MF, Akhtar I, Manucha V. Additional diagnostic features of mammary analogue secretory carcinoma on cytology. Cytopathology 2018;29:100–3.

    Article  CAS  Google Scholar 

  74. Bajaj J, Gimenez C, Slim F, Aziz M, Das K. Fine-needle aspiration cytology of mammary analog secretory carcinoma masquerading as low-grade mucoepidermoid carcinoma: case report with a review of the literature. Acta Cytol. 2014;58:501–10.

    Article  Google Scholar 

  75. Oza N, Sanghvi K, Shet T, Patil A, Menon S, Ramadwar M, Kane S. Mammary analogue secretory carcinoma of parotid: Is preoperative cytological diagnosis possible? Diagn Cytopathol. 2016;44:519–25.

    Article  Google Scholar 

  76. Ali SZ. Acinic-cell carcinoma, papillary-cystic variant: a diagnostic dilemma in salivary gland aspiration. Diagn Cytopathol. 2002;27:244–50.

    Article  Google Scholar 

  77. Shet T, Ghodke R, Kane S, Chinoy RN. Cytomorphologic patterns in papillary cystic variant of acinic cell carcinoma of the salivary gland. Acta Cytol. 2006;50:388–92.

    Article  Google Scholar 

  78. Mosunjac MB, Siddiqui MT, Tadros T. Acinic cell carcinoma-papillary cystic variant. Pitfalls of fine needle aspiration diagnosis: Study of five cases and review of literature. Cytopathology 2009;20:96–102.

    Article  CAS  Google Scholar 

  79. Kumar U. Acinic cell carcinoma papillary-cystic variant: diagnostic pitfalls in fine needle aspiration cytology. J Clin Diagn Res. 2017;11:ED05–6.

    Google Scholar 

  80. Jayaram G, Othman MA, Kumar M, Krishnan G. Papillary cystic type of acinic cell carcinoma of parotid: fine needle aspiration cytological features of a high grade variant with oncocytic metaplasia. Malays J Pathol. 2002;24:107–12.

    Google Scholar 

  81. Said-Al-Naief N, Carlos R, Vance GH, Miller C, Edwards PC. Combined DOG1 and mammaglobin immunohistochemistry is comparable to ETV6-breakapart analysis for differentiating between papillary cystic variants of acinic cell carcinoma and mammary analogue secretory carcinoma. Int J Surg Pathol. 2017;25:127–40.

    Article  CAS  Google Scholar 

  82. Al-Abbadi M. Metastases and rare primary neoplasms of salivary glands. In: Al-Abbadi M, editor. Salivary gland cytology. A color atlas. Wiley: Hoboken; 2011. pp. 215–41.

    Chapter  Google Scholar 

  83. Squillaci S, Marchione R, Piccolomini M. Cystic sebaceous lymphadenoma of the parotid gland: case report and review of the literature. Pathologica 2011;103:32–9.

    CAS  Google Scholar 

  84. Shilpi, Ahmad Ansari F, Bahadur S, Katyal A, Narula A, Nargotra N, Singh S. Sclerosing polycystic adenosis: a rare tumor misdiagnosed as retention cyst on fine needle aspiration cytology. Diagn Cytopathol. 2017;45:640–4.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, USA

    Liron Pantanowitz

  2. Pathology Department, Woodland Hills Medical Center, Woodland Hills, CA, USA

    Lester D. R. Thompson

  3. Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of Sacred Heart, Rome, Italy

    Esther Diana Rossi

  4. Department of Pathology, UPMC Shadyside UPMC Cancer Pavilion, Suite 20, 5150 Centre Ave, Pittsburgh, PA, 15232, USA

    Liron Pantanowitz

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Pantanowitz, L., Thompson, L.D.R. & Rossi, E.D. Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland. Head and Neck Pathol 12, 548–561 (2018). https://doi.org/10.1007/s12105-018-0904-8

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