Fine-Needle Aspiration Cytology of Lymphoproliferative Lesions Involving the Major Salivary Glands

Abstract

Fine-needle aspiration biopsy (FNA) is an accurate and cost-effective procedure for evaluating salivary gland lesions. Lymphoproliferative lesions may manifest as salivary gland enlargement. We report our experience with 43 cases of reactive and neoplastic lymphoproliferative lesions of the salivary glands evaluated by FNA, including 23 cases of reactive lymphoid hyperplasia and 20 neoplastic lymphoproliferative processes. The latter included 2 multiple myelomas and 18 non-Hodgkin lymphomas (small lymphocytic lymphoma/chronic lymphocytic leukemia, 1; small cleaved cell lymphoma, 1; lympho-plasmacytoid lymphoma, 1; mucosa-associated lymphoid tissue lymphoma, 2; mixed cell lymphoma, 4; lymphoblastic lymphoma, 1; and large cell lymphoma, 8). There were no false-negative diagnoses. Aspiration smears from 3 patients with reactive lymphoid hyperplasia and 4 patients with malignant lymphoma initially were interpreted as atypical lymphoid proliferations or as suggestive of malignant lymphoma. Thus, FNA had a sensitivity of 100% and a specificity of 87%. The majority of patients were treated medically without surgical intervention. Among the patients who underwent surgical resection of the salivary gland, 7 had an equivocal cytologic diagnosis and 2 had a benign cytologic diagnosis, but their parotid swelling failed to regress despite medical treatment. In most instances, FNA provides useful information for subsequent disease management and obviates surgical intervention.

Cytologic findings of marginal zone lymphoma

“…4,6 -9,11,12,15 Large transformed cells also are described frequently, as are the presence of small mature lymphocytes. 6,7,11,12,15 The cytologic characteristics described above are similar to our findings in the specimens from this series and are observed best in the DQ-stained slides, in which subtle differences in cell size and quantity of cytoplasm are enhanced compared with alcohol-fixed H&E or Papstained material.…”

“…4,5,12,13 Factors that contribute to this difficulty include heterogeneous morphologic features, lack of demonstrable LCR by FC, and a high number of reactive T-cells intermixed with the malignant B-cell component. 4,5,13,15 In a series of seven FNAB specimens and two bronchial washings, Matsushima et al reported that among all specimens with subsequent histologic confirmation of MZL at the same location as the FNAB, most cytologic specimens were composed of a polymorphous population of intermediate-sized lymphoid cells, transformed cells, and variable numbers of plasma cells.…”

Selected Topics on Lymphoid Lesions in the Head and Neck Regions

“…Neoplastic processes, on the other hand, frequently disrupt or replace the normal architecture. In addition, cytologic evaluation in conjunction with ancillary studies such as immunophenotyping by flow cytometric analysis of fine needle aspirate (FNA) specimens for B-and T-cell clonality can greatly enhance the ability of pathologists to distinguish benign from malignant lymphoproliferative disorders [2,3]. Indeed, FNA is often the initial method used to acquire material for pathologic assessment of these lesions.…”

Isolated extramedullary relapse of acute lymphoblastic leukemia in a submandibular salivary gland

“…Malignant lymphomas affect the salivary gland more frequently than leukemias. 1,2 Most malignant lymphomas of the salivary gland are seen in the context of Sjogren's syndrome. 3 Malignant lymphomas of the salivary glands represent 5% of the neoplasms of these glands.…”