Fine-Needle Aspiration Cytology Diagnosis of Pleomorphic Adenoma With Spontaneous Infarction in the Salivary Gland: A Multicenter Retrospective Study

IF 1.1 4区医学 Q4 CELL BIOLOGY

Cytopathology Pub Date : 2025-04-27 DOI:10.1111/cyt.13500

Jie-Qiong Wang, Ge Li, Shao-Hua Wang, Bo Yang, Yun Liu, Yu Wan, Cong-Gai Huang, Fan Li

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引用次数: 0

Abstract

Objective

Spontaneous infarction in salivary gland pleomorphic adenoma (PA) diagnosed by fine-needle aspiration cytology (FNAC) is rarely documented. This study aims to systematically analyse and summarise its cytopathological characteristics to reduce the risk of misdiagnosis and enhance diagnostic precision.

Methods

Five histopathologically confirmed cases (2017–2024) from two hospitals were retrospectively analysed. Clinical data, cytopathological findings and histopathology were reviewed, and causes of misdiagnosis were evaluated. Additionally, the cytopathological characteristics of salivary gland PA with spontaneous infarction were systematically analysed and comprehensively summarised, incorporating findings from relevant domestic and international literature.

Results

Only two cases (40%) were correctly diagnosed as PA or PA with infarction. Two cases (40%) were misdiagnosed as suspicious of malignancy, and one case (20%) was inconclusive. The cytopathological features are as follows: Fine-needle aspiration (FNA) specimens often appear as milky-white or brownish paste, with or without small tissue fragments. Microscopically, there is a background of necrotic debris with numerous scattered pleomorphic small cells resembling ‘naked nuclei’, characterised by hyperchromatic and irregular nuclei, accompanied by atypical squamous metaplastic cells, ‘ghost cells’ and eosinophilic cells with non-atypical nuclei, with or without the presence of tumour-associated glandular epithelial cells, myoepithelial cells, lymphocytes, neutrophils or other inflammatory cells, while mucinous or chondroid stroma is rarely observed or absent, and no abnormal mitotic figures are identified.

Conclusion

The cytological features of PA with spontaneous infarction can mimic malignancy. Recognising these features is crucial to reducing diagnostic errors and guiding appropriate management.

Abstract Image

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涎腺多形性腺瘤合并自发性梗死的细针穿刺细胞学诊断：一项多中心回顾性研究。

目的：涎腺多形性腺瘤（PA）经细针穿刺细胞学（FNAC）诊断为自发性梗死的病例很少。本研究旨在系统分析和总结其细胞病理学特征，以降低误诊风险，提高诊断精度。方法：回顾性分析两所医院2017-2024年5例组织病理学确诊病例。我们回顾了临床资料、细胞病理和组织病理结果，并对误诊原因进行了评估。并结合国内外相关文献，系统分析和综合总结自发性梗死涎腺PA的细胞病理学特征。结果：只有2例（40%）被正确诊断为PA或PA合并梗死。2例（40%）误诊为可疑恶性肿瘤，1例（20%）诊断不明确。细胞病理学特征如下：细针穿刺（FNA）标本常呈乳白色或褐色糊状，伴或不伴小组织碎片。显微镜下，背景为坏死碎片，有大量分散的多形性小细胞，类似于“裸核”，其特征是核深染和不规则，伴有非典型鳞状化生细胞、“鬼细胞”和嗜酸性细胞，细胞核非典型，有或没有肿瘤相关的腺上皮细胞、肌上皮细胞、淋巴细胞、中性粒细胞或其他炎症细胞。而粘液或软骨样基质很少观察到或不存在，也没有发现异常的有丝分裂象。结论：自发性梗死的PA具有类似恶性肿瘤的细胞学特征。认识到这些特征对于减少诊断错误和指导适当的管理至关重要。

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

Cytopathology 生物-病理学

CiteScore

2.30

自引率

15.40%

发文量

107

审稿时长

6-12 weeks

期刊介绍： The aim of Cytopathology is to publish articles relating to those aspects of cytology which will increase our knowledge and understanding of the aetiology, diagnosis and management of human disease. It contains original articles and critical reviews on all aspects of clinical cytology in its broadest sense, including: gynaecological and non-gynaecological cytology; fine needle aspiration and screening strategy. Cytopathology welcomes papers and articles on: ultrastructural, histochemical and immunocytochemical studies of the cell; quantitative cytology and DNA hybridization as applied to cytological material.