Enhanced performance of the Milan System for Reporting Salivary Gland Cytopathology: Point of view from an Asian country
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In this issue of Cancer Cytopathology , Lee et al describe their experience with the Milan system in Singapore in a retrospective study over 10 years. Diagnosing lymphoid lesions and Warthin tumors is often a challenging issue in salivary gland fine needle aspiration cytology.Keywords:
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Salivary gland cancer
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Salivary gland fine‐needle aspiration represents one of the most challenging areas of cytopathology; however, the discovery of several novel and/or next‐generation immunocytochemical and molecular markers for salivary gland tumors has resulted in greater diagnostic accuracy in cytologic diagnosis. In this commentary, recent advances in salivary gland cytopathology are reviewed with a focus on salivary gland tumors associated with gene rearrangements.
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Langerhans cell histiocytosis rarely involves the thyroid gland even in patients with multifocal disease. Unifocal disease apparently confined to the thyroid is even more rare.A 30-year-old woman presented with a 6-cm mass in the right and a 3-cm mass in the left lobe of the thyroid. Fine needle aspiration cytology showed isolated, loose aggregates and histiocytelike cells with grooved or contorted nuclei mixed in varying proportions with many mature eosinophils, scattered and small lymphocytes, multinucleated giant cells and foamy histiocytes.The cytologic features of Langerhans cell histiocytosis are characteristic. A fine needle aspiration cytology diagnosis is confirmed by histopathologic studies, imunohistochemical staining and ultrastructural studies.
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Langerhans Cell Histiocytosis
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To study the fine needle aspiration cytology of lymphoepithelial carcinoma of salivary gland (LECSG).Needle aspirates from five primary and two metastatic LECSGs were reviewed.Three aspirates showed very scant cellularity with rare tumor cells originally misinterpreted as lymphohistiocytic cells. Six fine needle aspiration biopsies (FNABs) contained medium to large polygonal and spindled cells with one or more prominent nucleoli. Five aspirates also displayed a heterogeneous population of lymphoid cells, while a sixth had much necrotic debris and only a few lymphocytes admixed with tumor cells.In the clinical setting of an Inuit or Chinese patient with a salivary gland mass, an FNAB with these features should suggest the possibility of LECSG.
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Background: A wide variety of benign and malignant tumours originate in the salivary glands and insufficient tumour cells make their diagnosis difficult in some patients. The aim of this study was to evaluate the efficacy of fine-needle aspiration cytology in the diagnosis of salivary gland lesions and to correlate cytological findings with histopathology. Materials and Methods: This was a prospective study done from September 2002 to May 2004. Fine needle aspiration cytology was performed in 58 patients with clinically significant salivary gland masses. Results: Fine needle aspiration cytology categorized 67.24% of the salivary gland lesions as neoplastic and 32.76% as non-neoplastic lesions. Amongst the neoplastic lesions, 76.9% were benign and 23.1% were malignant cases. Histopathological examination revealed that 81.05% of the cases were benign and 18.95% were malignant. Fine needle aspiration cytology had a sensitivity, specificity and diagnostic accuracy of 81.82%, 100% and 96.55%, respectively. The positive predictive value and negative predictive value was 100% and 95.9%, respectively. Conclusion: Fine needle aspiration of the salivary gland is a safe and reliable technique in the primary diagnosis of salivary gland lesions. Although, limitations are encountered while predicting specific lesions on cytology, especially when dealing with cystic and some malignant lesions, this study has shown that fine needle aspiration cytology has a high sensitivity, specificity and diagnostic accuracy in diagnosing salivary gland lesions. Keywords: Salivary glands; Fine needle aspiration cytology; Histopathology DOI: http://dx.doi.org/10.3126/jpn.v1i2.5403 JPN 2011; 1(2): 108-113
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Abstract We report here on five new cases of solid and cystic papillary neoplasm (SCPN) of the pancreas diagnosed by fine‐needle aspiration cytology (FNAC). All cytologic samples were obtained by ultrasonography, and the smears were conventionally fixed and stained. Special histochemical and immunocytochemical stains were also performed in some samples. Cytology revealed in all but one case numerous pseudopapillary structures composed of fibrovascular stalks lined with one or more layers of bland‐appearing, uniform tumor cells. The tumor cells had round‐to‐oval euchromatic nuclei with frequently folded smooth contours and one or two small nucleoli. Their cytoplasm often contained eosinophilic, PAS‐positive, and diastase‐resistant inclusions. Foamy cells, psammoma bodies, blood, and cellular debris were found in the background. The criteria for the differential diagnosis versus other pancreatic lesions are discussed in some detail, as is the role of immunocytochemistry (ICC). In the literature, only 28 cases of cytologically investigated SCPN have been reported to the best of our knowledge. The most helpful criteria for the conclusive identification of SCPN by FNAC include the pseudopapillary arrangement with bland‐appearing tumor cells, and, especially, the finding of acidophilic, PAS‐positive, and diastase‐resistant cytoplasmic granules. © 1995 Wiley‐Liss, Inc.
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Introduction: The characteristics of salivary gland lesions identified by fine-needle aspiration cytology are varied and may overlap, which makes diagnosis difficult for cytopathologists. To provide consistency in the reporting of salivary gland cytology and to enhance clinic-pathologic communication, the "Milan system for reporting salivary gland cytopathology" has been introduced, which offers guidelines for diagnosis and treatment based on various categories of malignancy risk. Material and Methods: In this retrospective study, Fine needle aspiration cytology was done for all salivary gland lesions for three years and were retrieved from the Department of pathology, Patan hospital. All the cases were recategorized according to the Milan system for reporting salivary gland cytology with histopathology follow-up wherever available. Consistency of the two different types of assessment techniques (Milan category and primary cytology diagnosis) were assessed and the k score was calculated Results: A total of 58 cases were included in the study of which histological follow-up was available in 27 cases. Out of 58 cases, maximum cases 32 (55.1%) were classified under IVA followed by 15.5% cases classified under II, 8.6% of cases under Category IVB), 6.8% under category Vand 5.1% cases under category VI. Kappa's score was 0.58 which represents a moderate agreement. Conclusions: Milan system for reporting salivary gland cytopathology is a recently proposed six-category scheme, which places salivary gland fine needle aspiration cytology into well-defined categories that limit the possibilities of false negative and false positive cases.
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Salivary gland cancer
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Fine-needle aspiration (FNA) is an accepted technique for the preoperative diagnosis of salivary gland nodules. The majority of salivary gland nodules are pleomorphic adenomas and offer little difficulty in diagnosis. Most diagnostically difficult lesions fall into one of four morphologic categories represented by squamous-cell-containing lesions, clear cell neoplasms, neoplasms with a prominence of stromal material, and lymphocyte-containing lesions. Herein, we describe our experience with a series of 61 histologically confirmed cases in which the smears contained a prominent or predominant number of lymphocytes. The differential diagnosis is discussed and points of diagnostic aid enumerated.
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To report on multinucleated giant cells (MNGCs) in salivary fine needle aspiration (FNA).The cytologic reports of salivary gland region FNA during a 10-year period was searched using the keyword giant cell in the final diagnosis or microscopic description. Cases with foreign body-type giant cells secondary to previous biopsy or FNA were excluded. Histologic correlations and immunohistochemical staining for CD68, CK, EMA, S100, HMB45 and CD1a were performed on selected cases.Twenty-six aspiration smears containing MNGCs were identified from 1040 salivary gland FNAs (2.5%). MNGCs were seen in some reactive or inflammatory conditions, benign neoplasms and malignant neoplasms. By type of MNGC, the salivary lesions were categorized in 3 groups: those with foreign body type, osteoclast type and tumor giant cells.MNGCs can be seen in a wide spectrum of salivary gland lesions ranging from reactive to benign and malignant. They are of nonepithelial origin or can be of true neoplastic nature in metastatic lesions.
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