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Difference between revisions of "Head and neck cytopathology"
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''Salivary gland cytopathology'' and ''salivary gland cytology'' redirect to here. | ''Salivary gland cytopathology'' and ''salivary gland cytology'' redirect to here. | ||
=Proposed Milan system for reporting salivary gland cytopathology= | |||
:''Milan system'' and ''Milan classification'' redirect here. | |||
{| class="wikitable" | |||
|- | |||
! Category | |||
! Typical management | |||
! Comments | |||
|- | |||
| Nondiagnostic | |||
| repeat FNA | |||
| | |||
|- | |||
| Nonneoplastic | |||
| follow-up/discharge | |||
| | |||
|- | |||
| Atypia of undetermined significance (AUS) | |||
| repeat FNA | |||
| use should be minimized <br>- like [[FLUS]] and [[ASCUS]] | |||
|- | |||
| Neoplasm | |||
| excision | |||
| subdivided into: (a) benign (b) salivary gland neoplasm of uncertain malignant potential (SUMP) | |||
|- | |||
| Suspicious for malignancy | |||
| wide excision +/-lymph nodes (?) | |||
| | |||
|- | |||
| Malignant | |||
| wide excision & lymph nodes (?) | |||
| | |||
|} | |||
Notes: | |||
*This classification is still evolving.<ref>URL: [http://www.cytopathology.org/the-milan-system-for-reporting-salivary-gland-cytopathology/ http://www.cytopathology.org/the-milan-system-for-reporting-salivary-gland-cytopathology/]. Accessed on: 31 March 2016.</ref> The preliminary version (above) was presented by Dr. William Faquin at [[USCAP]] 2016 in Seattle.<ref>URL: [http://www.uscap.org/meetings/detail/2016-annual-meeting/sessions/2334 http://www.uscap.org/meetings/detail/2016-annual-meeting/sessions/2334]. Accessed on: 13 March 2016.</ref> | |||
*The goal is to complete the reporting system by the summer of 2017. | |||
=Normal= | =Normal= | ||
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Sticky lymphoid tissue: | Sticky lymphoid tissue: | ||
*Irregular globs of tissue with small cells. | *Irregular globs of tissue with small cells. | ||
[[Skeletal muscle]]: | |||
*Round red staining globs +/-apparent striations. | |||
*Nuclei more at edges (peripheral). | |||
===Images=== | |||
<gallery> | |||
Image: Skeletal muscle - FNA 1 - intermed mag.jpg | SM - intermed. mag. | |||
Image: Skeletal muscle - FNA 1a- high mag.jpg | SM - high mag. | |||
Image: Skeletal muscle - FNA 1a- very high mag.jpg | SM - very high mag. | |||
Image: Skeletal muscle - FNA 1b- very high mag.jpg | SM - very high mag. | |||
Image: Skeletal muscle - FNA 2a- high mag.jpg | SM - high mag. | |||
Image: Skeletal muscle - FNA 2b- high mag.jpg | SM - high mag. | |||
Image: Skeletal muscle - FNA 2a- very high mag.jpg | SM - very high mag. | |||
Image: Skeletal muscle - FNA 2b- very high mag.jpg | SM - very high mag. | |||
</gallery> | |||
=Salivary gland tumours - summary= | =Salivary gland tumours - summary= | ||
| Line 100: | Line 153: | ||
*Squamous carcinoma. | *Squamous carcinoma. | ||
*Mucoepidermoid carcinoma. | *Mucoepidermoid carcinoma. | ||
==Crystals in salivary gland specimens== | |||
===General=== | |||
*Uncommon in general. | |||
**Typical location is: parotid (>85% salivary gland specimens with crystals<ref name=pmid33296146>{{cite journal |authors=Sun T, Faquin WC, Torous VF |title=Crystalloids in FNA specimens of salivary gland lesions: A retrospective study in a single large institute |journal=Cancer Cytopathol |volume=129 |issue=6 |pages=432–438 |date=June 2021 |pmid=33296146 |doi=10.1002/cncy.22395 |url=}}</ref>). | |||
*May be seen in the context of any diagnostic category (non-diagnostic, benign, neoplastic, malignant). | |||
**Approximately 40% of cases with crystals are benign or non-diagnositic.<ref name=pmid33296146/> | |||
**Approximately 10% of cases with crystals are suspicious or malignant.<ref name=pmid33296146/> | |||
DDx: | |||
*Amylase crystalloids ~ 75%. | |||
*Tyrosine crystalloids ~ 11%. | |||
*Collagenous crystalloids ~ 3%. | |||
*Undetermined type ~ 11%. | |||
===Cytology=== | |||
Features:<ref name=pmid33296146/><ref>{{cite journal |authors=Kishore M, Kaushal M, Dogra S |title=Crystalloids in salivary gland lesion: A diagnostic clue |journal=J Lab Physicians |volume=11 |issue=1 |pages=100–101 |date=2019 |pmid=30983813 |pmc=6437830 |doi=10.4103/JLP.JLP_120_18 |url=}}</ref> | |||
*Amylase crystalloids: rhomboid (or polygonal) +/- "pointy" ends, nonbirefringent. | |||
*Tyrosine crystalloids: floret-like structures, refractile. | |||
*Collagenous crystalloids: needle-shaped, radially arranged. | |||
===Sign out=== | |||
<pre> | |||
Crystalloid material is present and has a rhomboid/polygonal shape with occasional "pointy" ends; this is in keeping with amylase crystals. | |||
</pre> | |||
==Pleomorphic adenoma== | ==Pleomorphic adenoma== | ||
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*[[Adenoid cystic carcinoma]]. | *[[Adenoid cystic carcinoma]]. | ||
**Big circular globs (cysts) - common in AdCC. | **Big circular globs (cysts) - common in AdCC. | ||
==== | ====Images==== | ||
<gallery> | <gallery> | ||
Image: Pleomorphic adenoma - cytology -- high mag.jpg | PA - high mag. (WC) | Image: Pleomorphic adenoma - cytology -- high mag.jpg | PA - high mag. (WC) | ||
| Line 129: | Line 204: | ||
Image: Pleomorphic adenoma - cytology -- very high mag.jpg | PA - very high mag. (WC) | Image: Pleomorphic adenoma - cytology -- very high mag.jpg | PA - very high mag. (WC) | ||
Image: Pleomorphic adenoma - cytology - alt -- very high mag.jpg | PA - very high mag. (WC) | Image: Pleomorphic adenoma - cytology - alt -- very high mag.jpg | PA - very high mag. (WC) | ||
</gallery> | |||
<gallery> | |||
Image:Pleomorphic_adenoma_-_cytology.jpg | Pleomorphic adenoma. (WC) | |||
</gallery> | </gallery> | ||