Picture Atlas – FNA: Salivary gland – NUS Pathweb :: NUS Pathweb

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FINE NEEDLE ASPIRATION: salivary gland

Here are some examples of classical conditions, organised according to categories in The Milan System for Reporting Salivary Gland Cytology.

Click on the specific condition to view pic:

Milan Category: Classical cases

Non-neoplastic

- Normal
- Sialadenitis

Benign Neoplasm

Malignant

Non-neoplastic entities

case 1

Normal SC case 1

Diagnosis and Annotations

Normal salivary gland

Aspiration usually in microfragments of tissue.
Acinar cells forming grape-like clusters display an eccentric small round nuclei with indistinct nucleoli and abundant vacuolated cytoplasm.
Flat cohesive sheet of tubule of ductal cells display uniform, small cuboidal cells with round or oval nuclei and dense, sometimes squamoid, cytoplasm.
Fibrovascular stroma holding acinar and ductal cells together.
Adipose tissue can be seen.
Scattered bared acinar cell nuclei may mimic lymphocytes derives from intraparotid or adjacent lymph nodes.

case 2

Sialadenitis case 2

Diagnosis and Annotations

Benign Neoplasm

case 3

PA case 3

Diagnosis and Annotations

Pleomorphic adenoma (PA)

Epithelial cells ‘blend’ into stroma, becoming more spindled within the stroma.
Myoepithelial cells can appear in several forms: epithelioid, plasmacytoid and spindle-shaped and are commonly found within the metachromatic fibrillary stroma which stained intensely red to purple with Romanowsky stains.
Plasmacytoid cells may also be seen singly dispersed in the background.

case 4

WT case 4

Diagnosis and Annotations

Warthin Tumour

Aspiration may yield cyst fluid.
Flat cohesive monolayered sheets of oncocytes displaying round to oval, centrallu placed nuclei with bland chromatin and inconspicuous nucleoli and abundant densely granular cytoplasm which are orangeophilic.
Mixed population of background lymphocytes, mainly mature lymphocytes.
Amorphous and granular debris present in the background

case 5

Oncocytoma case 5

Diagnosis and Annotations

Oncocytoma

Cohesive, multilayered aggregates of oncocytes displaying round to oval, central placed nuclei with bland chromatin and inconspicuous nucleoli and abundant densely granular cytoplasm which is orangeophilic. Sometimes a nested architecture is discernible, unlike the flatter monolayered sheets seen in Warthin tumour.
Scattered bare nuclei may be present.
Absence of cyst debris and lymphocytes (both often present in Warthin tumour).
Oncocytoma vs nodular oncocytosis is difficult to distinguish with radiologic correlation.

malignant

case 6

ACC case 6.1

ACC case 6.2

ACC case 6.3

ACC case 6.4

Diagnosis and Annotations

Acinic Cell Carcinoma

Large branching tissue fragments with central vessels.
Polygonal neoplastic cells forming vague acinar structures.
The nuclei are usually round and fairly bland, sometimes with prominent nucleoli.
Cytoplasm is abundant and granular or vacuolated.
Bared round nuclei may be seen in the background.
DDx: Normal salivary gland parenchyma – Tighter, well-formed grape-like clusters; some lobules may also feature ductal cells; may also have adipose stroma (which is not seen in Acinic cell carcinoma).

case 7

ADCC case 7.1

ADCC case 7.2

ADCC case 7.3

ADCC case 7.4

ADCC case 7.5

Diagnosis and Annotations

Adenoid Cystic Carcinoma

Three variants: Tubular, cribriform and solid.
May present in combination.
Abundant acellular matrix which stains intensely metachromatic with Romanowsky stain while nearly invisible on Papanicolaou stain.
Matrix/stroma is arranged in discrete, large globules with sharp borders and sometimes as cylinders.
The cells are basaloid and uniform with oval to angulated, hyperchromatic nuclei and scant cytoplasm.
Cells often surround balls of matrix.
Sometimes bare oval nuclei are seen in the background.
Rarely, nucleoli, mitoses and necrosis may be observed in high-grade tumours.

case 8

MEC case 8.1

MEC case 8.2

MEC case 8.3

MEC case 8.4

Diagnosis and Annotations

Mucoepidermoid Carcinoma

Three cell types:
- Mucin-secreting cells: Eccentric nuclear with vacuolated cytoplasm which can be mistaken as histiocytes.
- Epidermoid cells: Polygonal and squamoid with dense cytoplasm.
- Intermediate cells: May have an immature squamous metaplasia-like appearance; or may exhibit relatively high N/C ratios.
Low-grade MECs are commonly cystic with abundant extracellular mucin and a predominance of mucin-secreting cells showing bland nuclear features.
- Because of the hypocellular nature and bland nuclei, low-grade MEC may be categorised as AUS or suspicious for malignancy, if there are insufficient definitive features for malignancy.
- DDx: Mucous retention cysts with squamous/mucinous metaplasia; Benign neoplasms with metaplastic changes.
High-grade MECs have a predominance of epidermoid cells with marked cytologic atypia, and may not be recognised specifically as MEC.

case 9

SDC case 9.1

SDC case 9.2

SDC case 9.3

SDC case 9.4

SDC case 9.5

Diagnosis and Annotations

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FNA: Salivary Gland

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