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(→Salivary gland tumours - summary: wikify, re-arr.) |
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Thyroid cytopathology is dealt with in the ''[[thyroid cytopathology]]'' article. An introduction to cytopathology is in the ''[[cytopathology]]'' article. | Thyroid cytopathology is dealt with in the ''[[thyroid cytopathology]]'' article. An introduction to cytopathology is in the ''[[cytopathology]]'' article. | ||
==Normal | ''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= | |||
Depends on the structure that is needled. | Depends on the structure that is needled. | ||
Line 12: | Line 50: | ||
*Nucleus: | *Nucleus: | ||
**Dispersed chromatin. | **Dispersed chromatin. | ||
**Indistinct nucleolus. | **Indistinct [[nucleolus]]. | ||
*Low NC ratio cells. | *Low [[NC ratio]] cells. | ||
Sticky lymphoid tissue: | Sticky lymphoid tissue: | ||
*Irregular globs of tissue with small cells. | *Irregular globs of tissue with small cells. | ||
==Salivary gland tumours - summary | [[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= | |||
===Benign=== | ===Benign=== | ||
{| class="wikitable" | {| class="wikitable" | ||
Line 36: | Line 91: | ||
| DDx (?) | | DDx (?) | ||
| ? | | ? | ||
| [ | | [[Image:Pleomorphic_adenoma_-_cytology.jpg | thumb| center| 150px| Pleomorphic adenoma. (WC)]] | ||
|- | |- | ||
| [[Warthin tumour]] (papillary cystadenoma lymphomatosum) | | [[Warthin tumour]] (papillary cystadenoma lymphomatosum) | ||
Line 44: | Line 99: | ||
| Acinic cell carcinoma (AcCC), oncocytoma | | Acinic cell carcinoma (AcCC), oncocytoma | ||
| AcCC: irregular spaced cells, lack well-defined cell borders | | AcCC: irregular spaced cells, lack well-defined cell borders | ||
| [ | | [[Image:Papillary_cystadenoma_lymphomatosum_cytology_high.jpg | thumb| center| 150px| Warthin tumour - high mag. (WC)]] | ||
|- | |- | ||
|} | |} | ||
Line 65: | Line 120: | ||
| Mucocele ? | | Mucocele ? | ||
| Nuclear atypia | | Nuclear atypia | ||
| [ | | [[Image:Mucoepidermoid_carcinoma_2_-_high_mag.jpg | thumb| center| 150px| Mucoepidermoid carcinoma. (WC)]] | ||
|- | |- | ||
| [[Adenoid cystic carcinoma]] (AdCC) | | [[Adenoid cystic carcinoma]] (AdCC) | ||
Line 73: | Line 128: | ||
| AcCC | | AcCC | ||
| Basement membrane material - PAS-D+ve<ref name=pmid62333>{{cite journal |author=Chen SY |title=Adenoid cystic carcinoma of minor salivary gland. Histochemical and electron microscopic studies of cystlike space |journal=Oral Surg. Oral Med. Oral Pathol. |volume=42 |issue=5 |pages=606–19 |year=1976 |month=November |pmid=62333 |doi= |url=}}</ref> | | Basement membrane material - PAS-D+ve<ref name=pmid62333>{{cite journal |author=Chen SY |title=Adenoid cystic carcinoma of minor salivary gland. Histochemical and electron microscopic studies of cystlike space |journal=Oral Surg. Oral Med. Oral Pathol. |volume=42 |issue=5 |pages=606–19 |year=1976 |month=November |pmid=62333 |doi= |url=}}</ref> | ||
| [ | | [[Image:Adenoid_cystic_carcinoma_cytology.jpg | thumb| center| 150px| Adenoid cystic carcinoma. (WC)]] | ||
|- | |- | ||
| [[Acinic cell carcinoma]] (AcCC) | | [[Acinic cell carcinoma]] (AcCC) | ||
Line 81: | Line 136: | ||
| Warthin tumour | | Warthin tumour | ||
| AcCC missing lymphocytic background; irreg. spacing of cells | | AcCC missing lymphocytic background; irreg. spacing of cells | ||
| [ | | [[Image:Acinic_cell_carcinoma.jpg | thumb| center| 150px| Acinic cell carcinoma. (WC)]] | ||
|} | |} | ||
=Salivary gland= | |||
{{Main|Salivary gland}} | |||
==Sialoadenitis== | |||
{{main|Chronic sialadenitis}} | |||
===Cytology=== | |||
Features: | |||
*Inflammatory cells - lymphocytes, plasma cells - '''key features'''. | |||
*+/-Squamous metaplasia. | |||
*+/-Necrotic debris. | |||
*Benign ductal epithelium. | |||
DDx: | |||
*Squamous carcinoma. | |||
*Mucoepidermoid carcinoma. | |||
==Pleomorphic adenoma== | ==Pleomorphic adenoma== | ||
General | {{Main|Pleomorphic adenoma}} | ||
*Abbreviated ''PA''. | |||
===General=== | |||
*Common benign tumour. | *Common benign tumour. | ||
===Cytology=== | ===Cytology=== | ||
Line 97: | Line 169: | ||
#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. | ||
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== | ||
*AKA ''papillary cystadenoma lymphomatosum''. | *AKA ''papillary cystadenoma lymphomatosum''. | ||
===General=== | |||
*Usual smokers. | |||
*May be bilateral. | |||
=== | ===Cytology=== | ||
Features:<ref>[http://sciencelinks.jp/j-east/article/200123/000020012301A0753392.php http://sciencelinks.jp/j-east/article/200123/000020012301A0753392.php]</ref> | Features:<ref>[http://sciencelinks.jp/j-east/article/200123/000020012301A0753392.php http://sciencelinks.jp/j-east/article/200123/000020012301A0753392.php]</ref> | ||
*Oncocytes. | *Oncocytes. | ||
Line 114: | Line 196: | ||
***Granular cytoplasm. | ***Granular cytoplasm. | ||
***Nucleoli. | ***Nucleoli. | ||
**Oncocytes are often associated with ''mast | **Oncocytes are often associated with ''[[mast cell]]s'', i.e. on "top of" oncocytes. | ||
***Mast cells: very granular dark staining cytoplasm (on smears). | ***Mast cells: very granular dark staining cytoplasm (on smears). | ||
*Lymphocytes. | *Lymphocytes. | ||
*Necrotic material (cyst contents). | *Necrotic material (cyst contents). | ||
DDx: | DDx: | ||
*Acinic cell carcinoma. | *[[Acinic cell carcinoma]]. | ||
**Spacing of tumour in AcCC is more irregular and appear more crowded. | **Spacing of tumour in AcCC is more irregular and appear more crowded. | ||
**The cell borders in AcCC is less obvious. | **The cell borders in AcCC is less obvious. | ||
*Oncocytoma | *Oncocytoma. | ||
**Oncocytoma (vis-a-vis Warthin tumour) has more '''c'''ells, more '''c'''ytoplasm, more granularity of '''c'''ytoplasm, more '''c'''omplex architecture.<ref name=boerner2003/> | **Oncocytoma (vis-a-vis [[Warthin tumour]]) has more '''c'''ells, more '''c'''ytoplasm, more granularity of '''c'''ytoplasm, more '''c'''omplex architecture.<ref name=boerner2003/> | ||
====Images==== | |||
<gallery> | |||
Image:Papillary_cystadenoma_lymphomatosum_cytology_high.jpg | Warthin tumour - high mag. (WC) | |||
Image:Papillary_cystadenoma_lymphomatosum_cytology_intermed.jpg | Warthin tumour - intermed. mag. (WC) | |||
Image:Papillary_cystadenoma_lymphomatosum2.jpg | Warthin tumour - surgical specimen. (WC) | |||
</gallery> | |||
==Oncocytoma== | ==Oncocytoma== | ||
*May be confused with Warthin tumour. | {{Main|Oncocytoma of the salivary gland}} | ||
===General=== | |||
*May be confused with [[Warthin tumour]]. | |||
===Cytology=== | |||
Features: | Features: | ||
*Oncocytes. | *Oncocytes. | ||
Line 149: | Line 236: | ||
==Mucoepidermoid carcinoma== | ==Mucoepidermoid carcinoma== | ||
{{Main|Mucoepidermoid carcinoma}} | {{Main|Mucoepidermoid carcinoma}} | ||
===General=== | |||
*A challenging FNA diagnosis.<ref name=pmid2296840>{{Cite journal | last1 = Cohen | first1 = MB. | last2 = Fisher | first2 = PE. | last3 = Holly | first3 = EA. | last4 = Ljung | first4 = BM. | last5 = Löwhagen | first5 = T. | last6 = Bottles | first6 = K. | title = Fine needle aspiration biopsy diagnosis of mucoepidermoid carcinoma. Statistical analysis. | journal = Acta Cytol | volume = 34 | issue = 1 | pages = 43-9 | month = | year = | doi = | PMID = 2296840 }}</ref> | |||
===Cytology=== | |||
Features: | Features: | ||
*Sheets of cells. | *Sheets of cells. | ||
Line 156: | Line 248: | ||
**Cell borders are often distinct. | **Cell borders are often distinct. | ||
DDx: | |||
*[ | *[[Squamous cell carcinoma]] - extensive keratinization and squamous pearls.<ref name=Ref_FNAC25>{{Ref FNAC|25}}</ref> | ||
===Images=== | |||
<gallery> | |||
Image:Mucoepidermoid_carcinoma_2_-_high_mag.jpg | Mucoepidermoid carcinoma. (WC) | |||
Image:Mucoepidermoid_carcinoma_2_-_very_high_mag.jpg | Mucoepidermoid carcinoma - very high mag. (WC) | |||
</gallery> | |||
==Acinic cell carcinoma== | ==Acinic cell carcinoma== | ||
{{Main|Acinic cell carcinoma}} | |||
===General=== | |||
*Uncommon. | |||
===Cytology=== | |||
Features:<ref>SB. 12 January 2010.</ref> | Features:<ref>SB. 12 January 2010.</ref> | ||
*Abundant granular cytoplasm. | *Abundant granular cytoplasm. | ||
Line 173: | Line 274: | ||
**Ductal structures (differentiates from normal). | **Ductal structures (differentiates from normal). | ||
Memory device: | |||
*[ | *AcCC - lots of "C"s: lots of cytoplasm, [[carcinoid]]-like (stippled chromatin, granular cytoplasm). | ||
====Image==== | |||
<gallery> | |||
Image:Acinic_cell_carcinoma.jpg | Acinic cell carcinoma - cytology. (WC) | |||
</gallery> | |||
==Adenoid cystic carcinoma== | ==Adenoid cystic carcinoma== | ||
===General=== | |||
*Usu. distinctive. | |||
*May be painful due the presence of [[perineural invasion]]. | |||
===Cytology=== | |||
Features: | Features: | ||
*Solid circular islands that are well-circumscribed. | *Solid circular islands that are well-circumscribed. | ||
Line 194: | Line 302: | ||
*Memory device: A'''d'''CC = lotsa '''D'''NA in relation to cell. | *Memory device: A'''d'''CC = lotsa '''D'''NA in relation to cell. | ||
Image: | ====Image==== | ||
* | <gallery> | ||
Image:Adenoid_cystic_carcinoma_cytology.jpg | Adenoid cystic carcinoma - cytology. (WC) | |||
</gallery> | |||
==Epithelial-myoepithelial carcinoma== | |||
{{Main|Epithelial-myoepithelial carcinoma}} | |||
===Cytology=== | |||
Features: | |||
*Single cells/stripped nuclei. | |||
*3-dimensional clusters. | |||
*Two cell population: | |||
**Dark small cells. | |||
**Light large cells. | |||
=Common= | |||
==Squamous carcinoma== | |||
{{Main|Squamous cell carcinoma}} | |||
*AKA ''squamous cell carcinoma''. | |||
===Cytopathology=== | |||
Features: | |||
*Mix of spindle cells/epithelioid cells, present in clusters, +/-small number of single cells. | |||
*Keratinization: | |||
**Orange/red staining on Pap stain. | |||
***Poorly differentiated SCC = not orange/red. | |||
**"Intense" (blue) staining of cells on rapid Romanowsky + pyknotic (small shriveled) nucleus.<ref>GS. 24 February 2010.</ref> | |||
*"Dense" appearing cytoplasm. | |||
**+/-Laminae (layers)/lines in the cytoplasm. | |||
*Nuclear features of malignancy (required for diagnosis): | |||
*#Irregular nuclear membrane, e.g. notches, sharp discontinuities. | |||
*#Nuclear hyperchromasia - "jet-black" nuclei on Pap stain '''key feature'''. | |||
*#Increased NC ratio. | |||
*#Variation of nuclear size from cell-to-cell. | |||
*#Granular chromatin. | |||
Notes: | |||
#One should see abnormal squamous cells to call it SCC. | |||
#Poorly differentiated SCC may look like [[adenocarcinoma]]. | |||
==Melanoma== | ==Melanoma== | ||
Line 206: | Line 351: | ||
***Nucleus typically eccentric. | ***Nucleus typically eccentric. | ||
*Brown granular cytoplasm; usually fine granularity. | *Brown granular cytoplasm; usually fine granularity. | ||
*Large red nucleoli (classic finding). | *Large [[red nucleoli]] (classic finding). | ||
*+/-Intranuclear inclusions. | *+/-Intranuclear inclusions. | ||
*+/-Binucleation. | *+/-Binucleation. | ||
Line 215: | Line 360: | ||
Notes: | Notes: | ||
#IHC stains are needed in many cases (S-100, HMB-45, Melan A). | #[[IHC]] stains are needed in many cases (S-100, HMB-45, Melan A). | ||
#The classic appearance of melanoma without pigment is closest to adenocarcinoma (which may have red nucleoli, large cells, abundant cytoplasm, occasional binucleation). | #The classic appearance of melanoma without pigment is closest to [[adenocarcinoma]] (which may have red nucleoli, large cells, abundant cytoplasm, occasional binucleation). | ||
#*Differentiating morphologic features: adenocarcinoma - 3-D clusters of cells, no spindle-shaped cells. | #*Differentiating morphologic features: adenocarcinoma - 3-D clusters of cells, no spindle-shaped cells. | ||
=Lymph nodes= | |||
==Normal lymph node== | |||
===Cytology=== | |||
*Mixed population of lymphoid cells. | *Mixed population of lymphoid cells. | ||
*+/-Lymphoglandular bodies. | |||
====Image==== | |||
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-044b.gif Lymphoglandular bodies in a DLBCL (ouhsc.edu)].<ref name=ouhsc_nine>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-024-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-024-M.htm]. Accessed on: 9 April 2012.</ref> | |||
== | ==Non-Hodgkin's lymphoma== | ||
=== | *[[AKA]] ''[[lymphoma]]''. | ||
===Cytology=== | |||
Features: | Features: | ||
*Population of monomorphous lymphoid cells. | *Population of monomorphous lymphoid cells - usu. ~2x the size of a RBC. | ||
*Lymphoglandular bodies - blue-grey bodies. | *Lymphoglandular bodies - blue-grey bodies. | ||
**Often about 1/2 the size of a RBC. | **Often about 1/2 the size of a RBC. | ||
***These may be seen in benign tissue. | ***These may be seen in benign tissue. | ||
===Hodgkin's lymphoma=== | Note: | ||
*[[Small cell lymphoma]]s cannot be diagnosed definitively from cytology. | |||
====Image==== | |||
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CI-Image-0803/FQ-044b.gif DLBCL with lymphoglandular bodies (ouhsc.edu)].<ref name=ouhsc_nine>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-024-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-024-M.htm]. Accessed on: 9 April 2012.</ref> | |||
==Hodgkin's lymphoma== | |||
{{Main|Hodgkin lymphoma}} | |||
===Cytology=== | |||
Features: | Features: | ||
*Reed-Sternberg cell (diagnostic). | *Reed-Sternberg cell (diagnostic). | ||
**Classically binucleated. | **Classically binucleated. | ||
**Huge cell with macronucleus. | **Huge cell with macronucleus. | ||
**Each nucleus has a huge | **Each nucleus has a huge macro[[nucleolus]]. | ||
***Macronucleolus approximately the size of a RBC. | ***[[Macronucleolus]] approximately the size of a [[RBC]]. | ||
*Commonly seen with eosinophils. | *Commonly seen with eosinophils. | ||
==Cystic lesions of the neck | Note: | ||
*RSCs are usually found at the edge of smears.<ref name=ouhsc_q26>URL: [http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-026-M.htm http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040/CQ-026-M.htm]. Accessed on: 9 April 2012.</ref> | |||
====Images==== | |||
<gallery> | |||
Image:Hodgkin_lymphoma_cytology_small.jpg | HL - higher mag. (WC) | |||
Image:Hodgkin_lymphoma_cytology_large.jpg | HL - lower mag. (WC) | |||
</gallery> | |||
www: | |||
*[http://moon.ouhsc.edu/kfung/jty1/CytoLearn/CytoQuiz/CQ-021-040-Ans/CI-Image-0803/FQ-046b.gif HL (ouhsc.edu)].<ref name=ouhsc_q26/> | |||
=Cystic lesions of the neck= | |||
===General=== | ===General=== | ||
*One should never sign-out a cytology specimen as: "[[branchial cleft cyst]]" or "[[thyroglossal duct cyst]]". | *One should never sign-out a cytology specimen as: "[[branchial cleft cyst]]" or "[[thyroglossal duct cyst]]". | ||
Line 247: | Line 418: | ||
===DDx=== | ===DDx=== | ||
Lateral: | Lateral: | ||
* | *[[Branchial cleft cyst]]. | ||
*Cystic hygroma. | *[[Cystic hygroma]]. | ||
Medial: | Medial: | ||
*Thyroglossal duct cyst. | *[[Thyroglossal duct cyst]]. | ||
Both: | Both: | ||
*Epidermoid cyst. | *[[Epidermoid cyst]]. | ||
*Cystic | *Cystic [[squamous cell carcinoma]]. | ||
=See also= | |||
*[[Cytopathology]]. | *[[Cytopathology]]. | ||
*[[Thyroid]]. | *[[Thyroid]]. | ||
*[[Head and neck pathology]]. | *[[Head and neck pathology]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Cytopathology]] | [[Category:Cytopathology]] |
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