Background
Fine‐needle aspiration (FNA) is a well‐established modality for diagnosing salivary gland pathologies. The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardized uniform framework leading to an evidence‐based risk of malignancy (ROM). Based on the current literature, ROM in the 6‐tier MSRSGC ranges from <5% for neoplasm‐benign to >90% for the malignant category. Here, we report our institutional experience adopting MSRSGC.
Methods
The cytopathology group at our institution implemented MSRSGC at the end of 2018. Through a query of our laboratory information system, we identified all salivary gland FNA cases from 27 November 2018 to 26 October 2020. The pertinent surgical pathology follow‐up was also extracted. After manual curation, data was analyzed in Rv4.0.2.
Results
Our cohort comprised of 315 patients undergoing 343 salivary gland FNA biopsies, predominantly on the parotid (90%), 162 with a surgical pathology follow‐up. The risk of malignancy ranged from 3.2% in neoplasm‐benign (IVA) to 100% in suspicious for malignancy (V) and malignant (VI) categories. ROM in the other categories was: 12.5% for non‐diagnostic, 0 for non‐neoplastic, 33.3% for atypia of undetermined significance, and 41.9% for salivary gland neoplasm of uncertain malignant potential (SUMP). Most SUMP cases had a basaloid or oncocytoid cytomorphology with similar ROM. In distinguishing benign and malignant salivary gland lesions, FNA had adequacy of 93.6%, a diagnostic yield of 62.2%, a sensitivity of 93.1% and a specificity of 100%.
Conclusions
MSRSGC was successfully adopted by our cytology group and clinicians, with overall diagnostic performance similar to previous studies.
Background: Ancillary studies are commonly performed on cell blocks prepared from fine-needle aspiration (FNA) specimens. There are limited studies in application of ancillary studies on cell blocks from salivary gland (SG) FNAs. This multi-institutional study evaluates the role of ancillary studies performed on cell blocks in the diagnosis of SG lesions, and their impact on clinical management.
Method:The electronic pathology archives of three large academic institutions were searched for SG FNAs with ancillary studies performed on cell blocks. The patient demographics, FNA site, cytologic diagnosis, ancillary studies, and surgical follow-up were recorded. If needed, the cytologic diagnoses were reclassified as per the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC).
Located in the mediastinum, pericardial cysts are rare and benign congenital abnormalities commonly identified as incidental findings on imaging. However, some patients with abnormally enlarged cysts present with compressive symptoms, which include recurrent infections, tamponade from cardiac compression and respiratory complications. Our report highlights a challenging case of a patient with recurrent respiratory symptoms secondary to phrenic nerve compression. Misdiagnosis over the past decade resulted in ineffective interventions. After clear identification of the cyst compression of the ipsilateral phrenic nerve, the patient underwent a minimally invasive robotically assisted cyst resection with phrenic nerve preservation that alleviated respiratory symptoms.
This case study describes a young man with symptoms suggestive of the presence of a space-occupying lesion within the cranial cavity. Imaging studies confirmed a lesion in the suprasellar region and surgical intervention to remove the tumor yielded an unexpected diagnosis. Neuroimaging characteristics and histopathology including immunohistochemistry are described. Gangliogliomas are uncommon CNS neoplasms and are most commonly found in the temporal and frontal lobes of young, male adults. They are rarely seen in the suprasellar region and only a handful of cases have been reported to date. The differential diagnoses associated with these suprasellar region lesions can be dependent on the age of the patient and neuroimaging characteristics. The present report highlights the importance of histopathological examination and the need to consider a wide range of diagnostic entities in the differential diagnosis of lesions in this topographic distribution, including rarely encountered tumors such as gangliogliomas.
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