Difference between revisions of "Head and neck cytopathology"

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Head and neck cytopathology (view source)

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[[Image:Pleomorphic adenoma - cytology -- high mag.jpg|right|thumb|[[Micrograph]] showing a pleomorphic adenoma. [[Pap stain]].]]
'''Head and neck cytopathology''' is a small part of cytopathology.  Non-cytopathology head & neck pathology is dealt with in the ''[[head and neck pathology]]'' article.
'''Head and neck cytopathology''' is a small part of cytopathology.  Non-cytopathology head & neck pathology is dealt with in the ''[[head and neck pathology]]'' article.


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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=
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*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.
====Images====
<gallery>
Image: Amylase crystals - parotid -- intermed mag.jpg | Amylase crystals - parotid - intermed. mag.
Image: Amylase crystals - parotid - alt -- intermed mag.jpg | Amylase crystals - parotid - intermed. mag.
Image: Amylase crystals - parotid -- high mag.jpg | Amylase crystals - parotid - high mag.
Image: Amylase crystals - parotid - alt -- high mag.jpg | Amylase crystals - parotid - high mag.
Image: Amylase crystals - parotid -- very high mag.jpg | Amylase crystals - parotid - very high mag.
Image: Amylase crystals - parotid - alt -- very high mag.jpg | Amylase crystals - parotid - very high mag.
Image: Amylase crystals - parotid - alt2 -- very high mag.jpg | Amylase crystals - parotid - very high mag.
Image: Amylase crystals - parotid -- high mag.gif | Amylase crystals - parotid - animation - high mag.
Image: Amylase crystals - parotid -- very high mag.gif | Amylase crystals - parotid - animation - very high mag.
</gallery>
===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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#Chondromyxoid stroma.
#Chondromyxoid stroma.
#*Whispy/fluffy groups of spindle cells that overlap (fibromyxoid tissue) - blue-ish.
#*Whispy/fluffy groups of spindle cells that overlap (fibromyxoid tissue) - blue-ish.
Image:
*[http://commons.wikimedia.org/wiki/File:Pleomorphic_adenoma_-_cytology.jpg Pleomorphic adenoma (WC)].


DDx:  
DDx:  
*[[Adenoid cystic carcinoma]].
*[[Adenoid cystic carcinoma]].
**Big circular globs (cysts) - common in AdCC.
**Big circular globs (cysts) - common in AdCC.
====Images====
<gallery>
Image: Pleomorphic adenoma - cytology -- high mag.jpg | PA - high mag. (WC)
Image: Pleomorphic adenoma - cytology - alt -- high mag.jpg | PA - 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)
</gallery>
<gallery>
Image:Pleomorphic_adenoma_-_cytology.jpg | Pleomorphic adenoma. (WC)
</gallery>


==Warthin tumour==
==Warthin tumour==
Michael
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