Archana Shetty

Role of fine-needle aspiration cytology in the diagnosis of major salivary gland tumors: A study with histological and clinical correlation

Introduction: Neoplastic lesions of salivary glands present an interesting subject because of their histologic diversification. Complex features exhibited by them have aroused considerable speculations concerning their histogenesis and continues to hold the interest of clinicians and pathologists. Major salivary glands are superficial and have easy accessibility for fine-needle aspiration cytology (FNAC). These glands are generally not subjected to incisional or core needle biopsy, because of the possible risks of fistula formation and tumor seedling. FNAC diagnosis of major salivary gland neoplasms aids in proper planning of required surgery and avoidance of the same in cases of non-neoplastic lesions. Materials and Methods: Cytological features of major salivary gland tumors diagnosed on FNAC were studied over a period of one and a half years. Cytological and architectural patterns in smears were compared with histopathological features in cases where the specimens were available with a note on the age, sex and presenting complaints. Statistical Analysis: Analysis of variance (ANOVA) was used to find the significance of study parameters. Chi-square/Fisher Exact was used to find the significance of study parameters on categorical scale between two or more groups. P value of <0.05 was considered to be significant. Results: A total of 114 salivary gland FNACs were done, 75 patients were clinically suspected to be neoplasms. The peak incidence was in the third to fourth decade of life with a female preponderance. Parotid was the most commonly affected gland (80%) with pleomorphic adenoma and mucoepidermoid carcinoma (10.7%) being the most common benign and malignant tumors respectively. The diagnostic accuracy of FNAC was 97.6%. Warthins tumor was misdiagnosed and was associated with a strong smoking history. Conclusion: Salivary gland neoplasms constitute a small but significant percentage of head and neck tumors. FNAC is inexpensive, quick, and aids in the preoperative diagnosis and planning of surgery.

Crystallizing galactocele: Report of a rare variation

The physiological changes of the breast during pregnancy and lactation make the clinical, radiological and pathological evaluation of a breast mass challenging. Galactoceles are benign lesions containing milk, and generally occur post partum. Fine needle aspiration cytology is a simple, quick and effective technique for the diagnosis of the same during this period, and in case of galactocele the same can be both diagnostic and therapeutic.Although the cytological features of galactocele are straight forward, a few rare interesting variations can be encountered posing a diagnostic challenge to the reporting cytopathologist. We present a case of galactocele in a twenty five year old lactating female with tyrosine crystals on cytology. Milk is composed of a wide variety of proteins and minerals, leading to the formation of calcium lactate or tyrosine crystals under rare circumstances when the milieu is acidic. This is one of the rare cases of crystallizing galactoceles reported in literature till date.

Amelanotic melanoma masquerading as a superficial small round cell tumor: a diagnostic challenge.

Malignant melanoma poses a remarkable capacity for morphological diversity and often presents as a diagnostic challenge due to its wide clinical presentation. We present a case of a 73-year-old lady, with a large superficial ulcerative nodular mass on the flexor aspect of the right upper arm. On fine needle aspiration poorly differentiated round cell tumor was suggested, with histopathology also supporting the same diagnosis. A final diagnosis of amelanotic melanoma was given following immunohistochemical work-up using a panel of relevant markers. We are presenting this case, not only for its rare clinical presentation, but also for the diagnostic difficulties encountered by us in cytology and histopathology to reach the final diagnosis.

Basal cell adenoma of the parotid gland: Cytological diagnosis of an uncommon tumor

Basal cell adenoma (BCA) is a rare benign epithelial tumor of the salivary gland, displaying monomorphic basaloid cells without a myxochondroid component, representing 1–3% of all salivary gland neoplasms seen predominantly in women over 50 years of age. It is uncommon in young adults. Cytodiagnosis of basaloid tumors chiefly basal cell adenoma of the salivary gland, is extremely challenging. The cytological differential diagnoses range from benign to malignant, neoplastic to non- neoplastic lesions. Histopathological examination is a must for definitive diagnosis, as these entities differ in prognosis and therapeutic aspects. We present a 22-years-old male with this uncommon diagnosis with a discussion on the role of cytological diagnosis. Fine needle aspiration cytology is a simple, minimally invasive method for the preoperative diagnosis of various types of neoplastic and non-neoplastic lesions. The knowledge of its pitfalls and limitations contributes to a more effective approach to treatment.

Reply to the comments of Sokouti et al.: Genitourinary hydatid disease.

At the outset, we appreciate the group of eminent practitioners who have read our article with interest. Regarding the queries raised, we would like to stress on the fact that we have mentioned both in introduction and beginning of the discussion that renal Echinococcosis is primarily caused by the larval form. Secondary or primary involvement of kidney is through hematogenous spread or through portal system into the liver and retroperitoneal lymphatics by a hydatid embryo (oncosphere) and not by the cyst perse. Hence, the sentence, ‘‘cysts pass through the portal system into the liver and retroperitoneal lymphatics to reach the kidneys’’ has been overlooked by us as the author of the reference (2) cited by us [Bhandarwar AH, Tayade MB, Makki K, Mhaske S (2009) Primary renal hydatid cyst. Bombay Hosp J 51(3):401–104] has wrongly quoted which we came to know when we retrieved their cross-reference for this point. We apologize for the same, and we agree that the authors of letter to editor have brought this point to our notice. We thank you for giving us the opportunity to review the letter to editor, and we request for the correction.