{"id":44898,"date":"2025-08-05T14:04:09","date_gmt":"2025-08-05T06:04:09","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=44898"},"modified":"2025-08-05T15:35:26","modified_gmt":"2025-08-05T07:35:26","slug":"sal-1","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/sal-1\/","title":{"rendered":"Mystery cases &#8211; Salivary gland 1"},"content":{"rendered":"\n<h2>\n\t\tsalivary gland case 1\n\t<\/h2>\n\t<h1>Jaw swelling<\/h1>\n\t<p><strong>Clinical history:<\/strong><strong>\u00a0<\/strong>A 65-year-old man presented with an enlarging lump at his left jaw. FNA of the lump is performed.<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal1.jpg\" alt=\"Salivary gland case 1\" itemprop=\"image\" height=\"1440\" width=\"1920\" title=\"Sal1\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal2.jpg\" alt=\"Sal2\" itemprop=\"image\" height=\"1440\" width=\"1920\" title=\"Sal2\" onerror=\"this.style.display='none'\"  \/>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-0\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-0\">Cytologic findings<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-0\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p>&nbsp;<\/p>\n<ul>\n<li>Epithelial cells arranged in small clusters, papilliform structures and single cells<\/li>\n<li>Enlarged nuclei and moderate nuclear pleomorphism<\/li>\n<li>Prominent nucleoli<\/li>\n<li>Abundant wispy cytoplasm<\/li>\n<li>Background necrosis<\/li>\n<li>No matrix or mucoid material seen<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-1\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-1\">Differential diagnosis<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-1\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\nThe cytomorphology is that of a high grade carcinoma and these entities may be morphologically indistinguishable:\n\u2043 Salivary duct carcinoma<br \/>\n\u2043 High-grade mucoepidermoid carcinoma<br \/>\n\u2043 Adenocarcinoma, NOS<br \/>\n\u2043 Metastatic adenocarcinoma\n<p>It is helpful to look for the presence of a low-grade component to suggest high grade transformation (e.g. carcinoma ex pleomorphic adenoma).\u00a0<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-2\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-2\">Cell block, immunocytochemistry and histology<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-2\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t&nbsp;<br \/>\nA cell block was available, showing sparse lesional cells. In view of the presence of high grade features and background necrosis, salivary duct carcinoma was suspected, and immunocytochemistry was performed:\u00a0\n<p><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal3.jpg\" alt=\"\" \/><\/p>\n<p>Immunocytochemistry: The tumour cells are positive for GATA3 and AR.<\/p>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal4.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal5.jpg\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>A complete resection was performed. Here are the histology pictures:\u00a0<\/p>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal6.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal7.jpg\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Histology shows islands of tumour cells with high nuclear grade, abundant eosinophilia cytoplasm and surrounding central comedonecrosis. A diagnosis of salivary duct carcinoma was made.\u00a0<\/p>\n<p>&nbsp;<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-3\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-3\">Diagnosis<\/a>\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--icon-3\" tabindex=\"-1\"><i title=\"Expand\">Expand<\/i><\/a>\n\t\t\t\t\t<p><strong>Malignant (Milan system, category VI)<\/strong><\/p>\n<p><strong>High grade carcinoma, with features suggestive of salivary duct carcinoma<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p>Note: Some cytologic clues to salivary duct carcinoma are the presence of high grade malignant features and background necrosis. A diagnosis may be suggested on cytology, and supported by the GATA3 and AR (Androgen receptor)-positive immunoprofile. However, on cytology, the more clinically important information that needs to be included in the report is the presence of malignancy and the high grade appearance of the malignant cells, even if the specific diagnosis may not be possible.\u00a0<\/p>\n\t<p><em>Case writer: Dr Noel Chia<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>salivary gland case 1 Jaw swelling Clinical history:\u00a0A 65-year-old man presented with an enlarging lump at his left jaw. FNA of the lump is performed. Cytologic findings Expand &nbsp; Epithelial cells arranged in small clusters, papilliform structures and single cells Enlarged nuclei and moderate nuclear pleomorphism Prominent nucleoli Abundant wispy cytoplasm Background necrosis No matrix [&hellip;]<\/p>\n","protected":false},"author":828,"featured_media":0,"parent":44933,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-44898","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>NUS Pathweb<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/sal-1\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"salivary gland case 1 Jaw swelling Clinical history:\u00a0A 65-year-old man presented with an enlarging lump at his left jaw. 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