Cytomorphologic features of papillary cystadenocarcinoma of the parotid

Abstract

The fine-needle aspiration cytology findings in four cases of recently classified cystadenocarcinoma of the parotid gland are reported. In three cases a recurrent tumor was aspirated. Smear preparations in all four cases were cellular, with numerous papillary projections, single cells, and sheets of cells in varying proportion in a proteinaceous to mucoid background. The background mucin was in varying proportions. The cells were cuboidal to tall columnar with basal nuclei and mild pleomorphism. The cytoplasm was dense in three cases with variable amounts of mucin. In one case (Case 4) the epithelial cells resembled mucin-secreting goblet cells, while in another case (Case 1) the cytoplasm showed multiple vacuolations. Mitosis was rare. Lymphoid tissue was seen in one case while macrophages and giant cells were seen in two cases. Epidermoid differentiation was absent in all four cases. Pathologic evaluation of the resected tumor confirmed the cytologic diagnosis. Clinical and radiologic evaluation failed to reveal any other potential primary site. Papillary cystadenocarcinomas of the parotid are rare but can be accurately diagnosed on FNAC. However, they need to be differentiated from mucoepidermoid and papillary acinic cell tumors.

Cytological features of cystadenocarcinoma in cyst fluid of the parotid gland: Diagnostic pitfalls and literature review

“…3 Cytological diagnosis of cystadenocarcinoma is important for differential diagnosis of benign lesions from malignant tumors with cystic growth, such as the papillary-cystic variant of acinic cell carcinoma (ACC-PCV), a low-grade mucoepidermoid carcinoma or cystadenoma, but there have been few reports regarding the cytological features of cystadenocarcinoma in fine-needle aspiration cytology (FNAC). [9][10][11][12] We report a case of cystadenocarcinoma arising from the parotid gland of a young man, for whom the preoperative cytological diagnosis was difficult, and discuss the differential diagnoses from a salivary gland lesion with prominent cystic structures.…”

Papillary cystadenocarcinoma of submandibular salivary gland: A rare case report

“…[4] Papillary cystadenocarcinomas of the salivary glands can be accurately diagnosed on FNAC. Kapila et al [6] have described the cytological features in a series of four cases of papillary cystadenocarcinomas of the parotid glands. Smear preparations in all four cases were cellular, with numerous papillary projections, single cells, and sheets of cells in varying proportion in a proteinaceous to mucoid background.…”

Cytopathology approach to rare salivary gland lesions with oncocytic features

“…The differential diagnosis of intraductal carcinoma of the salivary glands on FNAB includes a plethora of primary and metastatic neoplasms to the salivary glands, with oncocytic changes such as salivary gland cystadenocarcinoma (Figure A‐F), MASC, the papillary cystic variant of ACC, MEC (Figure A‐F), and metastatic breast carcinoma with apocrine features (Figure A‐F), among others. FNAB of salivary gland cystadenocarcinomas (Figure A‐D) is characterized by pseudo‐papillary sheets and clusters of medium to large‐sized epithelial cells, with abundant granular eosinophilic cytoplasm, round central nuclei, and prominent nucleoli . Histopathologic examination reveals (Figure E,F) prominent cystic dilation of glands, lined by eosinophilic cuboidal cells growing in fronds, and creating a pseudo‐papillary overall architecture .…”

“…FNAB of salivary gland cystadenocarcinomas (Figure A‐D) demonstrates pseudo‐papillary structures formed by medium to large‐sized epithelial cells, with abundant granular and vacuolated eosinophilic cytoplasm, round central mild to moderately atypical nuclei and prominent nucleoli, in a background of cystic debris . These features are typically not sufficient to differentiate between a benign and a malignant salivary gland neoplasm, placing CAC in the category of “neoplasm with uncertain malignant potential” upon cytopathology examination …”

“…67 Many cell types can be observed in CAC including small cuboidal (constituting the majority of the neoplastic cells), tall cuboidal, tall columnar, mucinous, finely vacuolated (soap-bubble like appearance), clear, oncocytic and rarely, focal epidermoid cells. 60,64,[68][69][70][71] Osseous metaplasia has also been observed in CAC. 72 Finally, it is worth mentioning that CAC can only be differentiated form cystadenoma histologically, by demonstrating an infiltrative growth into adjacent salivary gland tissue.…”