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Rotation - Cytopathology > Ch. 11 - Salivary Gland > Flashcards

Ch. 11 - Salivary Gland Flashcards

1
Q

What salivary gland tumors may tend to be cystic? What challenge does this confer on FNA?

A

Warthin tumor, low-grade mucoep, metastatic squamous cell carcinomas. Cystic lesions may result in false negatives.

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2
Q

What salivary gland tumors have a tendency to infarct?

A

Warthin tumor, oncocytoma, acinic cell carcinoma.

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3
Q

What salivary gland lesions tend to be bilateral?

A

Sialadenitis, amyloidosis, lymphoepithelial cysts, Warthin tumors, acinic cell carcinomas, lymphomas.

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4
Q

Distinguish between tyrosine and amylase crystalloids.

A

Tyrosine: Floret-shaped, typical of pleomorphic adenomas.
Amylase: Polygonal or needle-shaped.

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5
Q

What are the normal elements of salivary gland?

A

Serous or mucinous acinar cells (in rounded nests), ductal cells (flat sheets and tubules), adipose tissue.

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6
Q

What is a Kuttner tumor?

A

AKA chronic sclerosing sialadenitis; a lesion probably related to IgG4 with hypocellular aspirates.

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7
Q

Recall the different forms of sialadenitis.

A

Acute: Clinical diagnosis, not biopsied.
Chronic: More masslike, sparsely cellular.
Granulomatous: Many causes, incl. sarcoid, infection, neoplasia.
Lymphoepithelial: See separate card

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8
Q

What is sialadenosis?

A

A usually bilateral hypertrophy of acinar cells. Looks like normal gland on FNA.

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9
Q

What are some origins of squamous cysts?

A

Congenital: Dermoid, branchial cleft cyst

Simple lymphoepithelial cysts: Sjogren or HIV-related

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10
Q

What are some origins of mucinous cysts?

A

Malignant neoplasms, inflamatory conditions, mucoceles, retention cysts.

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11
Q

Describe the cytology of pleomorphic adenoma.

A

Honeycombed epithelial cells and spindled myoepithelial cells. Look for chondromyxoid matrix (looks mucinous) and tyrosine.

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12
Q

Where is pleomorphic adenoma generally found?

A

In the tail of the parotid gland.

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13
Q

Describe the cytology of myoepithelioma.

A

Loose aggregates and isolated spindled to epithelioid or plasmacytoid cells. NO epithelial cells or chondromyxoid matrix.

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14
Q

What is the relationship of myoepithelioma with pleomorphic adenoma?

A

It is considered a monomorphic variant of PA.

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15
Q

Describe the cytology of basal cell adenoma.

A

Small basaloid cells with peripheral palisading and a sharp demarcation to a dense non-fibrillary matrix. May have hyaline globules.

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16
Q

What are the histologic patterns of basal cell adenoma? What are their key associations?

A 
Solid
Tubular
Trabecular
Membranous (associated with hereditary syndromes)
Canalicular (tendency towards upper lip)
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17
Q

Distinguish between the cytology of a basal cell adenoma and an adenoid cystic carcinoma.

A

In basal cell adenoma, ribbons of BM material encase the cells, whereas in adenoid cystic the cells surround the BM material.

18
Q

Describe the cytology of Warthin tumor.

A

Oncocytes and lymphocytes with granular debris, maybe with some squamous or mucinous metaplasia.

19
Q

What is the clinical presentation of Warthin tumor?

A

Arises usually in parotid gland, sometimes bilaterally. Feels doughy and contains brown-green thick fluid.

20
Q

Describe the cytology of oncocytoma.

A

Cellular aspirate with oncocytes in trabeculae or sheets and no granular background. Cells have a sharp outline.

21
Q

Describe the cytology of mucoepidermoid carcinoma.

A

Combination of mucinous cells, epidermoid cells, and intermediate cells with extracellular mucin.

22
Q

How do low-grade and high-grade mucoepidermoid carcinomas differ in their cytology?

A

Low-grade has more mucinous cells (and may be cystic). High-grade has more squamoid cells present and is easier to recognize.

23
Q

Describe the cytology of acinic cell carcinoma.

A

Cellular aspirate with serous cells containing PAS+DR vacuolated cytoplasm. Nuclei are bland. Cell borders are indistinct.

24
Q

Describe the cytology of adenoid cystic carcinoma.

A

Large, 3-D hyaline matrix globules and basaloid cells that appear low-grade. Obviously cribriforming.

25
Q

What are the 3 variants of adenoid cystic carcinoma? What is its defining molecular feature?

A

Tubular, cribriform, and solid.

t(6;9) MYB-NFIB

26
Q

What is the most common translocation found in mucoepidermoid carcinoma?

A

t(11;19) MAML2-MECT1

27
Q

What salivary gland tumor has a tendency to express DOG1?

A

Acinic cell carcinoma.

28
Q

What are the three types of malignant mixed tumor in salivary gland?

A

Carcinoma ex-pleomorphic adenoma
Metastasizing mixed tumor
Carcinosarcoma

29
Q

Describe the cytology of salivary duct carcinoma.

A

Overtly malignant with bizarre cells in many configurations and abundant necrosis. Resembles comedo-type necrosis of breast IDC.

30
Q

Who does salivary duct carcinoma affect? What does it stain?

A

Older men, parotid glands. Expresses Her2 and androgen receptor.

31
Q

Describe the cytology of polymorphous low-grade carcinoma.

A

Tubules, cords, and linear groupings of cytologically uniform cells. (polymorphous refers to architecture)

32
Q

Describe the cytology of basal cell adenocarcinoma

A

Identical to that of basal cell adenoma (basaloid with encasing BM material), cannot be distinguished on FNA.

33
Q

Describe the cytology of epithelial-myoepithelial carcinoma.

A

3-D clusters of biphasic cells surrounded by BM material, sometimes proteinaceous spheres.

34
Q

What is the significance of clear cell carcinoma in salivary gland?

A

True clear cell NOS is rare. Most cases are actually other cancers with clear cell change.

35
Q

Describe the cytology of MASC.

A

Cellular aspirate in papillary or pseudopapillary arrangement, with vacuolated eosinophilic cytoplasm and pale mucoid material in background.

36
Q

Who does MASC affect? What is the diagnostic molecular feature?

A

Parotid glands of older men. Contains t(12;15) ETV6-NTRK5 translocation.

37
Q

How does primary small cell carcinoma of salivary gland differ from that of lung?

A

It is CK7-, CK20+, somewhat like Merkel cell carcinoma.

38
Q

What lymphomas are common in salivary gland?

A

Usually MALT lymphoma, follicular lymphoma, or DLBCL. Try to determine if you are sampling salivary gland or intragland lymph node.

39
Q

Describe the cytology of lymphoepithelial carcinoma.

A

Sheets of syncytial undifferentiated and pleomorphic cells. Lymphocytes and plasma cells.

40
Q

What are the key associations of lymphoepithelial carcinoma?

A

Geographically distributed in Greenland, southern China, and in Inuit populations. EBV driven, quite similar to nasopharyngeal carcinoma.

Rotation - Cytopathology (33 decks)

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