Cytological spectrum of salivary gland lesions and their correlation with epidemiological parameters

Abstract

Background: The role fine-needle aspiration (FNA) in the diagnosis of salivary gland lesions has evolved over the years. Although clinical and radiological parameters help to narrow the differential diagnosis the tissue diagnosis still remains the gold standard.

Materials and methods: This study is from January 2013 to December 2015 in our Department of Pathology where 170 salivary gland lesions were aspirated. The aim of the present study was to analyze adequacy rate in relation to the size of lesion and to evaluate varied cytological spectrum of salivary gland lesions with emphasis on differential diagnosis and to correlate cytological diagnosis with age, gender and anatomical site.

Results: The 170 cytological smears were categorized into two groups: Group 1 adequate aspirations (88.2%), Group 2 inadequate aspirations (11.7%). The adequate aspirations were subdivided as neoplastic (53.33%) and nonneoplastic (46.66%). The distribution of the various neoplastic lesions (80; 53.33%) were 66 (82.5%) benign, 12 (15%) were malignant and 2 (2.5%) were suspicious of malignancy. Among benign neoplasms, the pleomorphic adenoma (62; 93.3%) was the most frequent followed by Warthins tumor (4; 6%). The most common malignant neoplasms were adenoid cystic carcinoma (6; 50%), followed by mucoepidermoid carcinoma (4; 33.3%), malignant lymphoma (1; 8.3%) and metastatic carcinomatous deposits (1; 8.3%). In two cases, cytological picture indicated suspicion for malignancy however specific tumor typing could not be done. The neoplasms occurred more frequently in the parotid gland (65%), followed by submandibular gland (21.3%) and minor salivary glands (13.8%). The nonneoplastic lesions (70) included 68.6% cases of chronic sialadenitis, 17.1% cases were reported as mucocele, 11.4% cases of acute sialadenitis 2.9% cases as tubercular granulomas.

Conclusion: FNA cytology provides useful information on the management of salivary gland lesions and prevents unnecessary surgery in cases of nonneoplastic lesions and identification of malignancy helps the surgeon in deciding type and extent of surgery.

Keywords: Fine-needle aspiration cytology; salivary gland lesions; salivary gland neoplasms.

Figure 1

Cytological smear shows epithelial cells embedded in chondromyxoid stroma in case of pleomorphic adenoma, MGG, ×40

Figure 2

Smear shows myoepithelial cells exhibiting plasma cell differentiation in case of pleomorphic adenoma, H&E, ×40

Figure 3

Smear shows oncocytes admixed lymphomononuclear cells against dirty background in case of Warthins tumor, H&E, ×40

Figure 4

Cytological smear shows tumor cells along with hyaline globules in case of adenoid cystic carcinoma, MGG, ×40

Figure 5

Cytological smears show mucous secreting tumors cells in case of mucoepidermoid carcinoma, MGG, ×40

Figure 6

Smear shows epithelioid cell granuloma in case of tuberculosis of submandibular gland, H&E, ×40