Fine‐needle aspiration of normal tissue from enlarged salivary glands: Sialosis or missed target?

Abstract

Salivary gland enlargement by hypertrophy of normal-appearing parotid or submaxillary tissue is known as sialosis. It can be idiopathic, or may be associated with malnutrition, diabetes, bulimia, or alcoholism. When normal tissue is aspirated from an enlarged gland, one is tempted to diagnosed sialosis. We performed 26 such aspirates over a 5-yr period. In all cases, the cytology featured abundant acinar and ductal tissue in a clean (noninflammatory) background. Six cases were excluded when the records showed no return visits to the clinic. The remaining 20 patients included 9 men and 11 women, aged 24-92 yr (median 56), who harbored 12 parotid (2 bilateral) and 8 unilateral submaxillary enlargements. Clinical findings included ethanol abuse (2), diabetes (1), and previously diagnosed head and neck carcinoma (3). In six patients, the duration of the mass was described as months or years. Excision (6), reaspiration (3), radiographic evaluation (2), and clinical follow-up of patients not evaluated by other means (9 cases with median follow-up of 6 months) revealed no malignancies. One excised gland contained a pleomorphic adenoma measuring 0.5 cm in diameter. This had been diagnosed by repeat fine-needle aspiration (FNA) prior to surgery. We suggest that sialosis is a meaningful FNA diagnosis in patients who are carefully examined, skillfully aspirated, and reasonably followed.

Fine Needle Aspiration Biopsy of Salivary Gland Lesions

“…Sialosis is a meaningful FNAB diagnosis if based on a "normal" aspirate of salivary gland, in cases that are carefully examined, skillfully aspirated and reasonably followed. 27 The nuclear features of normal (nonneoplastic) acinar cells are, moreover, quite similar to those observed in acinic cell carcinoma. The only subtle difference is the smaller size of the nonneoplastic (normal) acinar cell nuclei as compared with neoplastic …”

Sialosis: Cytomorphological significance in the diagnosis of an uncommon entity

“…Acinic cell tumors generally yield abundant cellular material with poorly formed microacinar groupings. [7] Naked nuclei are absent in acinic cell tumors that are numerous in sialadenosis. Atypical nuclear features were more prominent in acinic cell tumors as compared to sialadenosis.…”

Acinic Cell Carcinoma:

“…In addition, the presence of ductal epithelium and increased fat, as well as the absence of chronic inflammatory cells in sialadenosis, also helps distinguish these 2 entities. 27 ACC showing abundant granular and dense cytoplasm may be confused with oncocytomas and Warthin tumors. ACC and oncocytoma both exhibit sheets of cells with abundant granular cytoplasm and bland nuclei.…”