Diagnostic challenges and problem cases in salivary gland cytology: A 20‐year experience

Salehi, Sajad; Maleki, Zahra

doi:10.1002/cncy.21949

Cited by 46 publications

(70 citation statements)

References 29 publications

(54 reference statements)

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“…However, this category brought us to the common pitfall usually seen in salivary gland tumors. Features that affected the classification of salivary gland cytology in a previous study by Salehi and Maleki included metaplastic change, reactive atypia, cystic change, cellularity of the lesion, and a prior history of malignancy …”

Section: Discussionmentioning

confidence: 99%

Risk of malignancy associated with cytomorphology subtypes in the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System: A bi‐institutional study

Chowsilpa

Lose

et al. 2019

Cancer Cytopathology

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BACKGROUND: Salivary gland neoplasm of uncertain malignant potential (SUMP) is a diagnostic category in the Milan System for Reporting Salivary Gland Cytopathology. The objective of this study was to assess the risk of neoplasm (RON) and the risk of malignancy (ROM) in SUMP cases by evaluating them based on their prominent cytomorphology. METHODS:The pathology databases were searched for cases of fine-needle aspiration-diagnosed SUMP at The Johns Hopkins Hospital and Northwestern University from 2013 to 2018. Only cytopathology cases diagnosed as SUMP that had available surgical follow-up were included. RESULTS: Sixty-five patients with SUMP were identified, including 31 men and 34 women who ranged in age from 15 to 87 years (mean age, 55.2 years). Sixty-five cases had histologic follow-up, including 13 (20%) with basaloid features, 13 (20%) with oncocytic features, and 39 (60%) with unspecified features. No cases with clear cell features were found. Overall, the RON in the SUMP category was 95.4% (62 of 65 cases), and the ROM was 33.8% (22 of 65 cases). The RON in SUMPs with basaloid, oncocytic, and unspecified subtypes was 92.3%, 100%, and 94.9%, respectively, whereas the ROM was 38.5%, 7.7%, and 41%, respectively. The most common benign neoplasm was pleomorphic adenoma (23.1%), whereas mucoepidermoid carcinoma (9.2%) was the most common malignant neoplasm. CONCLUSIONS: This study shows that the ROM differs significantly based on cytomorphology subtypes, whereas the overall ROM is approximately the same as the target rate in the Milan System for Reporting Salivary Gland Cytopathology. Moreover, the RON remains high in the SUMP category among different cytomorphology subtypes.Adequate sampling, immunohistochemical staining, and familiarity with metaplastic and reactive changes may improve the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Risk of malignancy associated with cytomorphology subtypes in the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System: A bi‐institutional study

Chowsilpa

Lose

et al. 2019

Cancer Cytopathology

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“…By FNAC, WT is characterized by the presence of three components: oncocytes, a polymorphous population of lymphocytes, and a grungy granular background (Figure ). While a bilayer of epithelium is appreciated histologically—with basal cells and more columnar oncocytic cells—this may not be as readily apparent cytologically.…”

Section: Benign Neoplasms and Lesionsmentioning

confidence: 99%

“…The differential for OC on FNAC includes WT, oncocytoma, and nodular oncocytic hyperplasia (NOH). WTs can usually be distinguished by the presence of a prominent lymphocytic component and a grungy background . Differentiating OC from oncocytoma and NOH is essentially impossible on cytologic grounds, though the presence of necrosis or cytologic atypia would strongly suggest the possibility of a malignancy .…”

Section: Malignant Neoplasmsmentioning

confidence: 99%

“…20 On multiphase CT, WTs demonstrate earlier peak enhancement with washout on delayed phase imaging in contrast to other benign and malignant lesions, which generally demonstrate progressive or stable enhancement on delayed phase imaging. 21 However, some imaging features overlap with malignant lesions: WT may demonstrate restricted diffusion on MRI 22,23 and are frequently FDG-avid on PET-CT. 24 By FNAC, WT is characterized by the presence of three components: oncocytes, a polymorphous population of lymphocytes, and a grungy granular background 25 (Figure 2). While a bilayer of epithelium is appreciated histologically-with basal cells and more columnar oncocytic cells-this may not be as readily apparent cytologically.…”

Section: Warthin Tumormentioning

confidence: 99%

“…WTs can usually be distinguished by the presence of a prominent lymphocytic component and a grungy background. 25 Differentiating OC from oncocytoma and NOH is essentially impossible on cytologic grounds, though the presence of necrosis or cytologic atypia would strongly suggest the possibility of a malignancy. 136 Oncocytic carcinomas are positive for CK5/6, CK8/18, CK10/13, and EMA while negative for SMA and S100.…”

Section: Oncocytic Carcinomamentioning

confidence: 99%

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The key radiologic and cytomorphologic features of oncocytic and oncocytoid lesions of the salivary gland

Lubin

Song

Zafar

et al. 2019

Diagnostic Cytopathology

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Oncocytic and oncocytoid lesions represent a distinct subset of salivary gland lesions. True oncocytic lesions of the salivary gland are entirely composed of oncocytes. These are characterized by the presence of abundant eosinophilic granules due to the presence of abundant cytoplasmic mitochondria. Oncocytic lesions of the salivary gland include oncocytosis, oncocytoma, and oncocytic carcinoma. In addition to the true oncocytic lesion, there exists another group of salivary gland lesions, which demonstrate cells with abundant and occasionally granular cytoplasm. These are often termed as “oncocytoid” lesions. The recently proposed Milan System for reporting salivary gland cytology clearly states that fine‐needle aspiration specimens representing oncocytic/oncocytoid lesions of salivary gland cannot effectively distinguish between a nonneoplastic lesion, benign and malignant neoplasms. Therefore, most lesions lacking classic cytomorphologic features will be classified under the umbrella diagnostic term of “Salivary Gland Neoplasm of Uncertain Malignant Potential” (SUMP). In this review, we discuss and illustrate key clinicopathologic and radiologic features that can help the practicing cytopathologist narrow down the differential and provide the best management based diagnosis.

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Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel

Johnson

Önenerk

Krane

et al. 2020

Cancer Cytopathology

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BACKGROUND: Fine needle aspiration (FNA) is commonly used for the preoperative evaluation of salivary gland tumors.Tumor grade is a key factor influencing clinical management of salivary gland carcinomas (SGCs). To assess the ability to grade nonbasaloid SGCs in FNA specimens, an international panel of cytopathologists convened to review and score SGC cases. METHODS: The study cohort included 61 cases of primary SGC from the pathology archives of 3 tertiary medical centers. Cases from 2005 to 2016 were selected, scanned, and digitized. Nineteen cytopathologists blinded to the histologic diagnosis reviewed the digitized cytology slides and graded them as low, high, or indeterminate. The panelists' results were then compared to the tumor grades based on histopathologic examination of the corresponding resection specimens. RESULTS:All but 2 of the 19 (89.5%) expert panelists review more than 20 salivary gland FNAs per year; 16 (84.2%) of the panelists work at academic medical centers, and 13 (68.4%) have more than 10 years' experience. Participants had an overall accuracy of 89.4% in the grading of SGC cases, with 90.2% and 88.3% for low-and high-grade SGC, respectively. Acinic cell carcinoma and mucoepidermoid carcinoma had the highest degree of accuracy, while epithelial-myoepithelial carcinoma and salivary duct carcinoma had the lowest degree of accuracy. As expected, the intermediate-grade SGC cases showed the greatest variability (high-grade, 42.1%; low-grade, 37.5%, indeterminate, 20.4%). CONCLUSION: This study confirms the high accuracy of cytomorphologic grading of primary SGC by FNA as low-or high-grade. However, caution should be exercised when a grade cannot be confidently assigned. Cancer Cytopathol 2020;128:392-402.

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Diagnostic challenges and problem cases in salivary gland cytology: A 20‐year experience

Cited by 46 publications

References 29 publications

Risk of malignancy associated with cytomorphology subtypes in the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System: A bi‐institutional study

Risk of malignancy associated with cytomorphology subtypes in the salivary gland neoplasm of uncertain malignant potential (SUMP) category in the Milan System: A bi‐institutional study

The key radiologic and cytomorphologic features of oncocytic and oncocytoid lesions of the salivary gland

Cytologic grading of primary malignant salivary gland tumors: A blinded review by an international panel

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