Head and neck cytopathology: Difference between revisions
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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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=Proposed Milan system for reporting salivary gland cytopathology= | =Proposed Milan system for reporting salivary gland cytopathology= | ||
:''Milan system'' | :''Milan system'' and ''Milan classification'' redirect here. | ||
{| class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
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| | | | ||
|- | |- | ||
| | | Atypia of undetermined significance (AUS) | ||
| repeat FNA | | repeat FNA | ||
| use should be minimized <br>- like [[FLUS]] and [[ASCUS]] | | use should be minimized <br>- like [[FLUS]] and [[ASCUS]] | ||
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| Neoplasm | | Neoplasm | ||
| excision | | excision | ||
| subdivided into: (a) benign (b) | | subdivided into: (a) benign (b) salivary gland neoplasm of uncertain malignant potential (SUMP) | ||
|- | |- | ||
| Suspicious for malignancy | | Suspicious for malignancy | ||
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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== | ||