Pitfalls in Salivary Gland Cytology.

IF 1.6 4区 医学 Q3 PATHOLOGY
Acta Cytologica Pub Date : 2024-01-01 Epub Date: 2024-02-28 DOI:10.1159/000538069
Carla Saoud, Gabrielle E Bailey, Ashleigh Graham, Lorena Marcano Bonilla, Sandra Ixchel Sanchez, Zahra Maleki
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引用次数: 0

Abstract

Background: Salivary gland lesions possess diagnostic challenges on fine-needle aspiration (FNA) material. They are relatively uncommon, yet present with a wide spectrum of cytomorphology. Herein, we review common salivary gland neoplasms, their cytomorphologic features, their diagnostic pitfalls, and ancillary studies helpful in achieving an accurate diagnosis.

Summary: There are many cytomorphologic overlaps between benign and malignant salivary gland entities. Moreover, metaplasia, cystic changes, and degenerative changes are common findings adding to diagnostic dilemmas. These complicating factors contribute to a minute risk of malignancy in salivary gland lesions that are interpreted as benign on FNA. In rare cases, even malignant salivary gland neoplasms are misinterpreted as benign on aspirated material due to the many cytomorphologic overlaps. For example, benign and malignant neoplasms containing stroma such as myoepithelioma and adenoid cystic carcinoma may be misinterpreted as pleomorphic adenoma. Moreover, diagnosis of salivary gland neoplasms with basal cell features can be confusing on FNA materials; for example, basal cell adenoma can be misinterpreted as adenoid cystic carcinoma. Mucoepidermoid carcinomas have many different appearances on aspirated material due to variable amounts of mucin, degree of nuclear atypia, cellular content, and squamous metaplasia. Acinic cell carcinoma exhibits large cells with abundant cytoplasm on FNA, which can be mistaken for oncocytic cells in oncocytoma or Warthin tumor. Salivary duct carcinoma shows distinct features of malignancy and thus can be mistaken for secondary tumors involving the salivary glands or other malignant salivary gland tumors. The presence of tumor-associated lymphocytes is another underlying cause of misdiagnosis, especially when considering the differential diagnosis of an intraparotid lymph node. Ancillary studies such as immunohistochemistry and molecular studies are gaining more attention to be utilized on FNA cases. PLAG1 immunostaining, CD117, DOG1, mammaglobin, and androgen receptor (AR) are examples of commonly used immunostains in diagnosis of salivary gland lesions. MYB gene fusion, rearrangements of the MAML2 gene, and ERBB2/HER2 are examples of molecular alterations useful in diagnosis of salivary gland neoplasms. In conclusion, the aim of salivary gland cytology is to differentiate benign entities from the malignant ones and to prevent unnecessary aggressive treatments.

Key messages: The diagnostic pitfalls are enormous in salivary gland cytology. Familiarity with cytomorphology of different entities and their cytomorphologic overlaps, and application of ancillary studies improves the diagnostic yield, patient management and prevents unnecessary aggressive procedures.

唾液腺细胞学的陷阱。
背景:唾液腺病变是细针穿刺(FNA)材料诊断的难题。它们相对来说并不常见,但在细胞形态学上却有广泛的表现。在此,我们将回顾常见的唾液腺肿瘤、其细胞形态学特征、诊断误区以及有助于获得准确诊断的辅助检查。此外,化生、囊性变和退行性变也是常见的检查结果,从而增加了诊断的难度。这些复杂因素导致在 FNA 中被解释为良性的唾液腺病变极有可能发生恶变。在极少数情况下,由于许多细胞形态学重叠,即使是恶性唾液腺肿瘤也会被误诊为良性。例如,含有基质的良性和恶性肿瘤(如肌上皮瘤和腺样囊性癌)可能会被误诊为多形性腺瘤。此外,诊断具有基底细胞特征的唾液腺肿瘤时,FNA 材料可能会造成混淆;例如,基底细胞腺瘤可能会被误诊为腺样囊性癌。黏液表皮样癌由于黏蛋白含量、核不典型程度、细胞含量和鳞状化生程度不同,在抽吸物上的表现也多种多样。醋酸细胞癌在 FNA 上表现为具有丰富细胞质的大细胞,这可能会被误认为是肿瘤细胞瘤或 Warthin 肿瘤中的肿瘤细胞。唾液腺导管癌表现出明显的恶性特征,因此可能被误认为是唾液腺继发性肿瘤或其他唾液腺恶性肿瘤。肿瘤相关淋巴细胞的存在是误诊的另一个潜在原因,尤其是在考虑腮腺内淋巴结的鉴别诊断时。免疫组化和分子研究等辅助研究越来越多地被用于 FNA 病例。PLAG1免疫染色、CD117、DOG1、乳球蛋白和雄激素受体(AR)是诊断唾液腺病变常用的免疫染色。MYB基因融合、MAML2基因重排和ERBB2/HER2是诊断涎腺肿瘤的分子改变实例。总之,涎腺细胞学检查的目的是区分良性和恶性肿瘤,避免不必要的侵略性治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Acta Cytologica
Acta Cytologica 生物-病理学
CiteScore
3.70
自引率
11.10%
发文量
46
审稿时长
4-8 weeks
期刊介绍: With articles offering an excellent balance between clinical cytology and cytopathology, ''Acta Cytologica'' fosters the understanding of the pathogenetic mechanisms behind cytomorphology and thus facilitates the translation of frontline research into clinical practice. As the official journal of the International Academy of Cytology and affiliated to over 50 national cytology societies around the world, ''Acta Cytologica'' evaluates new and existing diagnostic applications of scientific advances as well as their clinical correlations. Original papers, review articles, meta-analyses, novel insights from clinical practice, and letters to the editor cover topics from diagnostic cytopathology, gynecologic and non-gynecologic cytopathology to fine needle aspiration, molecular techniques and their diagnostic applications. As the perfect reference for practical use, ''Acta Cytologica'' addresses a multidisciplinary audience practicing clinical cytopathology, cell biology, oncology, interventional radiology, otorhinolaryngology, gastroenterology, urology, pulmonology and preventive medicine.
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