Spontaneous infarction of a pleomorphic adenoma in parotid gland: Diagnostic problems and review

Abstract

Although infarction of parotid gland pleomorphic adenoma (PA) following fine-needle aspiration (FNA) has been well-documented, spontaneous infarction of PA has remained as an uncommon entity in the literature. To our knowledge, we report the second case of spontaneous infarction occurring in a parotid gland PA. A 44-yr-old man presented with a 2-yr history of slowly enlarging right parotid mass, which had become painful 1 mo before performing FNA biopsy. Smears revealed abundant necrotic debris, atypical squamous cells, and small cells with dark nuclei suggestive of a carcinoma. Histologic examination of the tissue fragments demonstrated degenerated clusters of cells and chondromyxoid matrix. The parotidectomy specimen had features consistent with those of an infarcted PA. Although appears to be rare, spontaneous infarction of PA should be considered in the differential diagnosis, since necrosis may mimic carcinoma and cause misinterpretation of necrosis as an indication of malignancy, in an otherwise benign salivary gland neoplasm.

Cytologic Diagnostic Accuracy in Pleomorphic Adenoma of the Salivary Glands During 2 Periods

“…Malignancy should be considered when atypical cells are abundant and show an abnormal chromatin pattern. Since spontaneous infarction is rare in PA, 30 the existence of necrosis is a worrisome feature.…”

Spontaneous infarction of pleomorphic adenoma: Report of a case simulating malignancy on fine‐needle cytology sample

“…4 In the salivary glands, partial or total infarction may be caused by FNC sampling 7,9 or may be a spontaneous event and may concern benign tumors or malignancies. 8,11 In Warthin's tumor, post-FNC infarction may lead to sudden increase in volume of the affected gland, coupled to pain or tenderness. 7 In analogy to what described in the thyroid, infarction of malignant tumors may impede the histopathological diagnosis.…”

WCAFTI: Worrisome cytologic alterations following tissue infarction; a mimicker of malignancy in breast cytology

“…1 In 1993, infarction of a fibroadenoma of breast following FNA was reported by McCutcheon and Lipa. 2 On the contrary, cytomorphologic changes due to prior tissue infarction which are worrisome in FNA aspirates and squash cytology have occurred 3,4 but not been stressed in practice. The acronym ''WCAFTI'' (cafti) is very apt in these situations.…”

“…2 An occasional report focuses on spontaneous infarction of pleomorphic adenoma 3 and intraductal papilloma of the breast 4 presenting at FNA and the potential problems and pitfalls in their diagnoses at cytology. We have applied the acronym WCAFTI (cafti)-[Worrisome cytologic alterations following tissue infarction] for the entity which describes the spectrum of cytologic changes seen in infarction of a lesion.…”