{"id":44920,"date":"2025-08-05T14:04:00","date_gmt":"2025-08-05T06:04:00","guid":{"rendered":"https:\/\/medicine.nus.edu.sg\/pathweb\/?page_id=44920"},"modified":"2025-08-05T15:40:06","modified_gmt":"2025-08-05T07:40:06","slug":"sal-3","status":"publish","type":"page","link":"https:\/\/medicine.nus.edu.sg\/pathweb\/cytopath\/cyto-mystery-cases\/sal-3\/","title":{"rendered":"Mystery cases &#8211; Salivary gland 3"},"content":{"rendered":"\n<h2>\n\t\tsalivary gland case 3\n\t<\/h2>\n\t<h1>Another Salivary gland tumour<\/h1>\n\t<p><strong>Clinical history:<\/strong> A 50 year old male presented with an enlarged left submandibular gland.<\/p>\n<p>A fine needle aspiration of the mass was performed.<\/p>\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal14.jpg\" alt=\"Salivary gland case 3\" itemprop=\"image\" height=\"960\" width=\"1280\" title=\"Sal14\" 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 and Differential Diagnoses<\/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<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal15.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal16.jpg\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<ul>\n<li>Sheets and clusters of epithelial cells<\/li>\n<li>Low grade nuclear\u00a0atypia: oval nuclei with small nucleoli, fine chromatin, irregular nuclear membranes and mild pleomorphism<\/li>\n<li>Variable amounts of cytoplasm &#8211; ranging from moderate to abundant multivacuolated cytoplasm in some cells<\/li>\n<li>Background shows some mucin\u00a0<\/li>\n<\/ul>\n<p>Relevant negative findings:<\/p>\n<ul>\n<li>No intracytoplasmic granules<\/li>\n<li>No prominent stromal\/matrix material<\/li>\n<li>No background myoepithelial cells\u00a0<\/li>\n<li>No background lymphocytes\u00a0<\/li>\n<li>No background necrosis<\/li>\n<\/ul>\n<p>The features are those of a low grade epithelial neoplasm with moderate to abundant cytoplasm.<\/p>\n<p>The differential diagnoses include:<\/p>\n<ul>\n<li>Low grade mucoepidermoid carcinoma<\/li>\n<li>Acinic cell carcinoma<\/li>\n<li>Secretory carcinoma<\/li>\n<li>Intraductal carcinoma<\/li>\n<\/ul>\n<p>See below for discussion of differential diagnoses.<\/p>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-1\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-1\">Cell Block and Histology<\/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 \/>\n<img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal17.jpg\" alt=\"\" \/>\n<ul>\n<li>Sheets of epithelial cells with low grade nuclear atypia<\/li>\n<li>Occasional lumina formation<br \/>\n<\/li>\n<\/ul>\n<table>\n<tbody>\n<tr>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal18.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal19.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal20.jpg\" alt=\"\" \/><\/td>\n<td><img decoding=\"async\" src=\"https:\/\/medicine.nus.edu.sg\/pathweb\/wp-content\/uploads\/2025\/06\/Sal21.jpg\" alt=\"\" \/><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<ul>\n<li>Microcystic \/ sieve-like, papillary and micropapillary architecture<\/li>\n<li>Some lumina contain mucin<\/li>\n<li>Vesicular, overlapping, mildly enlarged nuclei\u00a0<\/li>\n<li>Moderate amounts of eosinophilic cytoplasm<\/li>\n<\/ul>\n\t\t\t\t\t<a href=\"#\" id=\"fl-accordion--label-2\" tabindex=\"0\" aria-controls=\"fl-accordion--panel-2\">Diagnosis and Discussion<\/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 \/>\n<strong>Secretory carcinoma<\/strong>\n<p>A definitive morphologic cytologic diagnosis of secretory carcinoma is difficult as there is often some degree of cytomorphologic overlap with acinic cell carcinoma, mucoepidermoid carcinoma (low grade) and intraductal carcinoma.<\/p>\n<p>The salient, but non-specific, cytomorphologic features of secretory carcinoma include the presence of epithelioid cells arranged in sheets, clusters, papillae and as single dispersed cells. The nuclear features are low grade, characterized by mild nuclear enlarged, membrane irregularity and small nucleoli. Identifying the presence of moderate to abundant cytoplasm with multivacuolation may be a helpful clue. These cells may also have an oncocytoid appearance. Another clue is the presence of mucoid or proteinaceous material in the background.<\/p>\n<p>Discussion of differential diagnosis<\/p>\n<ul>\n<li>Acinic cell carcinoma contains sheets of poorly formed acini and numerous naked nuclei in the background. The tumour cells contain a central prominent nucleolus and occasional cytoplasmic zymogen granules. The cytoplasm may appear multivacuolated and may at times be inseparable from secretory carcinoma on cytology.<\/li>\n<li>Mucoepidermoid carcinoma is composed\u00a0of distinct cell types including polygonal squamous \/ intermediate cells with dense cytoplasm\u00a0and mucinous epithelial cells with abundant univacuolated cytoplasm.<\/li>\n<li>The diagnosis of intraductal carcinoma is difficult and almost impossible on cytology. Tumour cells appear as sheets, small clusters and single cells with low grade nuclear atypia and moderate amounts of cytoplasm. The background is usually clean and devoid of necrosis. The morphologic pattern resembles low grade ductal carcinoma in situ of the breast<\/li>\n<\/ul>\n\t<p><em>Case writer: Dr Noel Chia<\/em><\/p>\n\n","protected":false},"excerpt":{"rendered":"<p>salivary gland case 3 Another Salivary gland tumour Clinical history: A 50 year old male presented with an enlarged left submandibular gland. A fine needle aspiration of the mass was performed. Cytologic Findings and Differential Diagnoses Expand &nbsp; &nbsp; Sheets and clusters of epithelial cells Low grade nuclear\u00a0atypia: oval nuclei with small nucleoli, fine chromatin, [&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-44920","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-3\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:description\" content=\"salivary gland case 3 Another Salivary gland tumour Clinical history: A 50 year old male presented with an enlarged left submandibular gland. 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