Ch. 11 - Salivary Gland Flashcards
What salivary gland tumors may tend to be cystic? What challenge does this confer on FNA?
Warthin tumor, low-grade mucoep, metastatic squamous cell carcinomas. Cystic lesions may result in false negatives.
What salivary gland tumors have a tendency to infarct?
Warthin tumor, oncocytoma, acinic cell carcinoma.
What salivary gland lesions tend to be bilateral?
Sialadenitis, amyloidosis, lymphoepithelial cysts, Warthin tumors, acinic cell carcinomas, lymphomas.
Distinguish between tyrosine and amylase crystalloids.
Tyrosine: Floret-shaped, typical of pleomorphic adenomas.
Amylase: Polygonal or needle-shaped.
What are the normal elements of salivary gland?
Serous or mucinous acinar cells (in rounded nests), ductal cells (flat sheets and tubules), adipose tissue.
What is a Kuttner tumor?
AKA chronic sclerosing sialadenitis; a lesion probably related to IgG4 with hypocellular aspirates.
Recall the different forms of sialadenitis.
Acute: Clinical diagnosis, not biopsied.
Chronic: More masslike, sparsely cellular.
Granulomatous: Many causes, incl. sarcoid, infection, neoplasia.
Lymphoepithelial: See separate card
What is sialadenosis?
A usually bilateral hypertrophy of acinar cells. Looks like normal gland on FNA.
What are some origins of squamous cysts?
Congenital: Dermoid, branchial cleft cyst
Simple lymphoepithelial cysts: Sjogren or HIV-related
What are some origins of mucinous cysts?
Malignant neoplasms, inflamatory conditions, mucoceles, retention cysts.
Describe the cytology of pleomorphic adenoma.
Honeycombed epithelial cells and spindled myoepithelial cells. Look for chondromyxoid matrix (looks mucinous) and tyrosine.
Where is pleomorphic adenoma generally found?
In the tail of the parotid gland.
Describe the cytology of myoepithelioma.
Loose aggregates and isolated spindled to epithelioid or plasmacytoid cells. NO epithelial cells or chondromyxoid matrix.
What is the relationship of myoepithelioma with pleomorphic adenoma?
It is considered a monomorphic variant of PA.
Describe the cytology of basal cell adenoma.
Small basaloid cells with peripheral palisading and a sharp demarcation to a dense non-fibrillary matrix. May have hyaline globules.
What are the histologic patterns of basal cell adenoma? What are their key associations?
Solid Tubular Trabecular Membranous (associated with hereditary syndromes) Canalicular (tendency towards upper lip)
Distinguish between the cytology of a basal cell adenoma and an adenoid cystic carcinoma.
In basal cell adenoma, ribbons of BM material encase the cells, whereas in adenoid cystic the cells surround the BM material.
Describe the cytology of Warthin tumor.
Oncocytes and lymphocytes with granular debris, maybe with some squamous or mucinous metaplasia.
What is the clinical presentation of Warthin tumor?
Arises usually in parotid gland, sometimes bilaterally. Feels doughy and contains brown-green thick fluid.
Describe the cytology of oncocytoma.
Cellular aspirate with oncocytes in trabeculae or sheets and no granular background. Cells have a sharp outline.
Describe the cytology of mucoepidermoid carcinoma.
Combination of mucinous cells, epidermoid cells, and intermediate cells with extracellular mucin.
How do low-grade and high-grade mucoepidermoid carcinomas differ in their cytology?
Low-grade has more mucinous cells (and may be cystic). High-grade has more squamoid cells present and is easier to recognize.
Describe the cytology of acinic cell carcinoma.
Cellular aspirate with serous cells containing PAS+DR vacuolated cytoplasm. Nuclei are bland. Cell borders are indistinct.
Describe the cytology of adenoid cystic carcinoma.
Large, 3-D hyaline matrix globules and basaloid cells that appear low-grade. Obviously cribriforming.
What are the 3 variants of adenoid cystic carcinoma? What is its defining molecular feature?
Tubular, cribriform, and solid.
t(6;9) MYB-NFIB
What is the most common translocation found in mucoepidermoid carcinoma?
t(11;19) MAML2-MECT1
What salivary gland tumor has a tendency to express DOG1?
Acinic cell carcinoma.
What are the three types of malignant mixed tumor in salivary gland?
Carcinoma ex-pleomorphic adenoma
Metastasizing mixed tumor
Carcinosarcoma
Describe the cytology of salivary duct carcinoma.
Overtly malignant with bizarre cells in many configurations and abundant necrosis. Resembles comedo-type necrosis of breast IDC.
Who does salivary duct carcinoma affect? What does it stain?
Older men, parotid glands. Expresses Her2 and androgen receptor.
Describe the cytology of polymorphous low-grade carcinoma.
Tubules, cords, and linear groupings of cytologically uniform cells. (polymorphous refers to architecture)
Describe the cytology of basal cell adenocarcinoma
Identical to that of basal cell adenoma (basaloid with encasing BM material), cannot be distinguished on FNA.
Describe the cytology of epithelial-myoepithelial carcinoma.
3-D clusters of biphasic cells surrounded by BM material, sometimes proteinaceous spheres.
What is the significance of clear cell carcinoma in salivary gland?
True clear cell NOS is rare. Most cases are actually other cancers with clear cell change.
Describe the cytology of MASC.
Cellular aspirate in papillary or pseudopapillary arrangement, with vacuolated eosinophilic cytoplasm and pale mucoid material in background.
Who does MASC affect? What is the diagnostic molecular feature?
Parotid glands of older men. Contains t(12;15) ETV6-NTRK5 translocation.
How does primary small cell carcinoma of salivary gland differ from that of lung?
It is CK7-, CK20+, somewhat like Merkel cell carcinoma.
What lymphomas are common in salivary gland?
Usually MALT lymphoma, follicular lymphoma, or DLBCL. Try to determine if you are sampling salivary gland or intragland lymph node.
Describe the cytology of lymphoepithelial carcinoma.
Sheets of syncytial undifferentiated and pleomorphic cells. Lymphocytes and plasma cells.
What are the key associations of lymphoepithelial carcinoma?
Geographically distributed in Greenland, southern China, and in Inuit populations. EBV driven, quite similar to nasopharyngeal carcinoma.
