Journal of Pathology and Translational Medicine

Original Article

Accuracy of Core Needle Biopsy Versus Fine Needle Aspiration Cytology for Diagnosing Salivary Gland Tumors: In Hye Song, Joon Seon Song, Chang Ohk Sung, Jong-Lyel Roh, Seung-Ho Choi, Soon Yuhl Nam, Sang Yoon Kim, Jeong Hyun Lee, Jung Hwan Baek, Kyung-Ja Cho; J Pathol Transl Med. 2015;49(2):136-143. Published online March 12, 2015; DOI: https://doi.org/10.4132/jptm.2015.01.03

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Background
Core needle biopsy is a relatively new technique used to diagnose salivary gland lesions, and its role in comparison with fine needle aspiration cytology needs to be refined. Methods: We compared the results of 228 ultrasound-guided core needle biopsy and 371 fine needle aspiration procedures performed on major salivary gland tumors with their postoperative histological diagnoses. Results: Core needle biopsy resulted in significantly higher sensitivity and more accurate tumor subtyping, especially for malignant tumors, than fine needle aspiration. No patient developed major complications after core needle biopsy. Conclusions: We recommend ultrasoundguided core needle biopsy as the primary diagnostic tool for the preoperative evaluation of patients with salivary gland lesions, especially when malignancy is suspected.

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Case Studies

Oncocytic Lipoadenoma: A Rare Case of Parotid Gland Tumor and Review of the Literature: Chen-lin Chi, Tseng-tong Kuo, Li-yu Lee; J Pathol Transl Med. 2015;49(2):144-147. Published online March 12, 2015; DOI: https://doi.org/10.4132/jptm.2014.02.10

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Abstract PDF

Oncocytic lipoadenoma is a rare tumor, with only 18 cases having been reported since the first in 1998. We encountered a case of oncocytic lipoadenoma presenting as a slowly growing parotid mass in a 71-year-old man. This tumor is characteristically comprised of a mixture of oncocytes and adipocytes. The present case is one of five reported cases of oncocytic lipoadenoma showing sebaceous differentiation. The results of immunohistochemical study with DOG1 antibody supported the origination of this tumor in the striated duct.

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Oncocyitic lipoadenoma of the parotid gland
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Otorinolaringologia.2021;[Epub] CrossRef
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Domenico Corradi, Rodolfo Monaco, Giulia D'Angelo, Paola Bini, Teore Ferri, Enrico M Silini
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Diffuse Large B-Cell Lymphoma Arising in Warthin's Tumor: Case Study and Review of the Literature: Güliz Özkök, Funda Taşlı, Nazan Özsan, Rafet Öztürk, Hakan Postacı; Korean J Pathol. 2013;47(6):579-582. Published online December 24, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.6.579

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Abstract PDF

Warthin's tumor is the second most common type of salivary gland tumor. Microscopically, Warthin's tumor displays a proliferative epithelial component and lymphoid stroma. Carcinomas arising from the epithelial component are well known, but malignant transformations of the lymphoid stroma are rare. When they do occur, they are most commonly B-cell type non-Hodgkin lymphomas. A 60-year-old male patient underwent surgical resection of a parotid mass. After superficial parotidectomy, microscopic examination indicated that the tumor was of epithelial components with basaloid and oncocytic columns of cells neighboring lymphoid components. In addition to the lymphoid follicles with distinct germinal centers, there were large, bizarre and extremely atypical neoplastic cells seen in the lymphoid component. Large neoplastic cells were diffusely CD20 and CD30 positive. The patient was diagnosed with "Warthin's tumor and diffuse large B-cell lymphoma with expression of CD30." The histopathologic and clinical features are discussed along with a review of the literature.

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Warthin’s Tumor of the Parotid Gland With Degeneration to Diffuse Large B-cell Lymphoma: A Case Report and Review of Literature
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Follicular Lymphoma Diagnosed in Warthin Tumor: A Case Report and Review of the Literature
Fnu Alnoor, Jatin S. Gandhi, Matthew K. Stein, Joel F. Gradowski
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Prevalence of Lymphoid Neoplasia in a Retrospective Analysis of Warthin Tumor: A Single Institution Experience
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Diffuse large B-cell lymphoma arising from follicular lymphoma with warthin’s tumor of the parotid gland - immunophenotypic and genetic features: A case report
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Presentation of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma in a Warthin Tumor: Case Report and Literature Review
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Case Reports

Osteoclast-like Giant Cell Tumor of the Parotid Gland Accompanied with Carcinoma ex Pleomorphic Adenoma.: Mi Jung Kwon, Eun Sook Nam, Seong Jin Cho, Hyung Sik Shin, Ji Hyun Kwon, Young Soo Rho; Korean J Pathol. 2011;45:S84-S88.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S84

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Abstract PDF

The origin of osteoclast-like giant cell tumor (OGCT) of the salivary gland has been debated because the prototypic cells of osteoclast-like cells and mononuclear stromal cells are largely unexplained in this gland. Bone marrow-derived CD14+ and CD45+ monocyte-derived multipotential cells (CD14+/CD45+ MOMC) may be one of the possible origins of OGCTs of salivary glands, which have never been explored in salivary OGCTs. We present a case of OGCT accompanied with carcinoma ex pleomorphic adenoma in the parotid gland of a 67-year-old Korean female. The tumor presented as a rapidly growing cervical mass comprising a central area of carcinoma ex pleomorphic adenoma and a peripheral circumferential area of OGCT. The immunohistochemical staining pattern was phenotypically consistent with bone marrow-derived CD14+/CD45+ MOMC. This case is the first report of a salivary OGCT in Korea.

Citations

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Tumeur à cellules géantes de type ostéoclastique de la parotide
S. Rammeh, I. Hergli, M.K. M’farrej, N. Znaidi, S. Nechi, R. Zermani
Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale.2014; 115(3): 185. CrossRef

Sclerosing Polycystic Adenosis of the Parotid Gland: A Case Report.: Byung Joo Jeong, Mi Ran Kim, Zhe Long Liang, Bon Seok Koo, Jin Man Kim; Korean J Pathol. 2011;45:S79-S83.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S79

4,087 View
44 Download
3 Crossref

Abstract PDF

Sclerosing polycystic adenosis (SPA) of the salivary glands is a rare entity analogous to fibrocystic disease of the breast. Less than 50 cases of SPA have been published in the literature. We report the first Korean case of SPA of the right parotid gland. A 34-year-old man presented with a slowly growing right parotid mass. Computed tomography showed a relatively well-demarcated, heterogeneously enhancing mass with multiple small calcifications. Fine needle aspiration showed cohesive sheets of epithelial cells with granular oncocytic cytoplasm and scattered lymphocytes. The parotidectomy specimen showed a 3 cm-sized solid nodular lesion with small cysts. Microscopically, the lesion was an unencapsulated mass of sclerotic fibrous tissue with cystic ducts, multiple calcifications, and lymphoplasma cell infiltration. Sclerosing adenosis and cystic ducts with frequent apocrine-like cells were noted. Familiarity with the cytologic and histological features of SPA is very important making the correct diagnosis.

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Juvenile sclerosing polycystic adenosis cytologically mimicking Warthin tumor
Masataka Kawai, Tomohiro Inoue, Takaaki Yonaga, Kunio Mochizuki, Tadao Nakazawa, Keisuke Masuyama, Tetsuo Kondo
Diagnostic Cytopathology.2019; 47(11): 1208. CrossRef
A Case of Sclerosing Polycystic Adenosis of Parotid Gland
Young-Jun Kim, Jang-Won Choi, Young-Joong Kim, Soo-Kweon Koo
Korean Journal of Otorhinolaryngology-Head and Neck Surgery.2014; 57(8): 559. CrossRef

Parotid Gland Carcinosarcoma with Osteosarcoma as a Sarcomatous Component: A Case Report with Fine Needle Aspiration Cytologic Findings.: Se Min Jang, Young Jin Jun, Hulin Han, Ki Seok Jang, Seung Sam Paik; Korean J Pathol. 2011;45(4):412-416.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.4.412

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Abstract PDF

Carcinosarcoma of the salivary glands is a rare malignant tumor showing both malignant epithelial and mesenchymal components. Herein, we present a carcinosarcoma of the parotid gland in a 67-year-old man consisting of osteosarcoma and adenocarcinoma components with fine needle aspiration cytological findings. The tumor was composed predominantly of osteosarcoma and small areas of adenocarcinomatous components and a hyalinized nodule reminiscent of pleomorphic adenoma. The tumor showed infiltrative growth features with perineural, lymphatic, and vascular invasion. Despite postoperative adjuvant radiation therapy, multiple metastatic lesions occurred in the both lungs 5 months after surgery. As salivary gland carcinosarcoma has been known to demonstrate highly aggressive behavior, an accurate pathological diagnosis is prerequisite for appropriate treatment.

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Carcinosarcoma of the parotid gland with abdominal metastasis: a case report and review of literature
Chang Gok Woo, Seung-Myoung Son
World Journal of Surgical Oncology.2018;[Epub] CrossRef

Benign Lymphoepithelial Cyst: A case report.: Jin Haeng Chung, Gyeong Hoon Kang, Je G Chi; Korean J Pathol. 1996;30(6):551-553.

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Abstract PDF: An intraparotid benign lymphoepithelial cyst is a rare disease characterized by unilateral painless swelling of parotid region. The histogenesis is controversial. Surgical excision is recommended for diagnosis and curative treatment. We present a case of benign lymphoepithelial cyst arising in a patient with neurofibromatosis. A 46-year-old woman presented with a slowly growing multilocular cystic mass in the left cheek. The cystic mass measured 4 cm in maximal outer diameter and the cystic wall was thick and yellowish pale to gray, soft with well circumscribed margin. Microscopically, the multilocular cyst was lined by stratified squamous epithelium for the most part and underlying lymphoid tissue aggregates with follicles and sharply demarcated from adjacent salivary parenchyma which is of normal appearance and without lymphoid aggregates. Since this lesion is absolutely benign, it is important to separate this benign cyst from cystic salivary gland tumors.

Congenital Sialoblastoma: A case report and review.: Jong In Yook, Hee Jeong Ahn, Jin Kim; Korean J Pathol. 1997;31(11):1227-1232.

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Abstract: A congenital salivary gland tumor, sialoblastoma, is extremely rare. A sialoblastoma of the parotid gland, occurring in a 28-week old fetus, is described. The histologic, immunohistochemical, and ultrastructural features of this tumor were studied. The tumor was characterized by solid nests or sheets of tumor cells intermingled with ductal structures lined by a columnar cells. Some of the tumor cells showed squamous differentiation. Immunohistochemically, these epidermoid cells reacted positively with anti-cytokeratin. But anti-S-100, anti- vimentin, anti-smooth muscle actin, anti-GFAP positive cells were not found. The ultrastructure was characterized by primitive epithelial cells. Although various names have been proposed, we favored the term "sialoblastoma". The histogenesis of this tumor is also discussed.

Malignant Myoepithelioma Arising in a Recurrent Pleomorphic Adenoma: A case report.: Jeong Yu Kyung, Yeon Lim Suh; Korean J Pathol. 1999;33(7):517-520.

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Abstract PDF: Malignant myoepithelioma is a rare neoplasm of salivary gland which may either arise de novo or develop in a pre-existing pleomorphic adenoma. The malignant myoepithelioma occurs in 0.45% of major salivary gland tumors. Malignant myoepitheliomas arising in the pleomorphic adenoma number less than 20 in English literature and 1 in Korea. We describe a case of malignant myoepithelioma arising in a recurrent pleomorphic adenoma of the left parotid gland of a 61-year-old man. The tumor was ill-defined and composed of polygonal or plasmacytoid myoepithelial cells. Infiltration to surrounding tissue, hemorrhage, necrosis, increased mitotic activity and vascular tumor emboli indicated its malignant nature. There were several satellite nodules with histologic features of typical pleomorphic adenoma. Immunohistochemically, tumor cells were reactive for S-100 protein, AE1/AE3, vimentin, smooth muscle actin and glial fibrillary acid protein.

Fine Needle Aspiration Cytology of Malignant Myoepithelioma of the Salivary Gland: A Case Report.: Jae Hwa Lee, Jean Kyung Park, Bang Hur; Korean J Cytopathol. 2002;13(1):28-32.

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Abstract PDF: Malignant myoepithelioma (myoepithelial carcinoma), is a very rare malignant epithelial neoplasm accounting for less than 1% of all salivary gland tumors and has an intermediate malignant potential. We report a case of malignant myoepithelioma arising in the left parotid gland in a 54-year-old man, which was difficult to differentiate from pleomorphic adenoma and other malignant salivary gland neoplasms. Fine needle aspiration cytology of the parotid gland showed cellular smear, composed of overlapped sheets and clusters or individually scattered tumor cells without any acinic or ductal structures. The tumor cells were rather uniform, with distinct cell borders and moderate amount of cytoplasm. The eccentrically located nuclei were oval to round and pleomorphic and showed prominent nucleoli. A few clear cells were noted in the cellular aggregates. Metachromatic matrix was seen between individual tumor cells in a lacelike fashion, resembling pleomorphic adenoma. According to the immunohistochemical staining, we recognized that the component cells are myoepithelial in nature, showing reactivity for the S-100 protein, vimentin, and actin.

Epithelial-Myoepithelial Carcinoma of the Parotid Gland: Report of a Case Misinterpreted as Pleomorphic denoma on Fine Needle Aspiration Cytology.: Dong Chul Kim, Ahwon Lee, Kyo Young Lee, Cang Suk Kang, Sang In Shim; Korean J Cytopathol. 2002;13(1):42-46.

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Abstract PDF: Epithelial-myoepithelial carcinoma(EMC) is a rare, low grade malignant tumor of the salivary glands. The EMC has a distinctive histological appearance comprising ductal structures with an inner epithelial cell component and an outer layer of myoepithelial cells which show plump clear cytoplasm. The cytologic features of the EMC have been rarely described. A correct cytological diagnosis to this rare tumor is difficult with high false negative rate. We report a case of EMC in which fine needle aspiration cytologic findings were misinterpreted as a pleomorphic adenoma.

Fine Needle Aspiration Cytology of Lymphoepithelial Carcinoma of Parotid Gland: A Case Report.: Sung Jig Lim, Jung Yeon Kim, Kyeong Mee Park; Korean J Cytopathol. 2002;13(2):74-77.

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Abstract PDF: Lymphoepithelial carcinoma, also known as malignant lymphoepithelial lesion or lymphoepithelioma, is a rare tumor in salivary glands. Lymphoepithelial carcinoma has a characteristic histological findings comprising irregularly-shaped nests of malignant epithelial cells within a lymphocyte-rich stroma, occasionally forming lymphoid follicles. We recently experienced a case of fine needle aspiration cytology(FNAC) of lymphoepithelial carcinoma of parotid gland in a 61-year-old male. The FNAC yielded a hypercellular smear of many irregular clusters of malignant epithelial cells in the background of lymphoid stroma.

Fine Needle Aspiration Cytology of Chronic Sclerosing Sialadenitis with Mucinous Metaplasia in Parotid Gland: A Case Report.: Jae Yeon Seok, Woo Hee Jung, Xu Xiang Fan, Jin Kim, Soon Won Hong; Korean J Cytopathol. 2005;16(2):102-105.

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Abstract PDF: Chronic sclerosing sialadenitis, also known as Kuttner tumor, is a benign chronic inflammatory lesion of the salivary gland. Here, we describe a case of chronic sclerosing sialadenitis with mucinous ductal metaplasia in a parotid gland, which was confused with low-grade mucoepidermoid carcinoma on aspiration cytology.

Fine Needle Aspiration Cytology of the Warthin's Tumor Misinterpretated as Squamous Cell Carcinoma: A Case Report.: Kyungji Lee, Chan Kwon Jung, Ahwon Lee, Kyo Young Lee, Chang Suk Kang; Korean J Cytopathol. 2005;16(2):106-109.

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Abstract PDF: We report a case of Warthin's tumor of the parotid gland in a 53?year?old man, which is incorrectly diagnosed as squamous cell carcinoma. Fine needle aspiration cytology(FNAC) smear obtained from the right parotid gland revealed scattered epithelial cell clusters or nests in a diffuse inflammatory and necrotic background. Some epithelial cells had squamoid appearance showing variable sized bizarre shaped nuclei. They had abundant of dense eosinophilic keratinized cytoplasm. Occasionally, parakeratotic cells were also present. These cytologic findings with significant atypia and necrotic background made diagnosis as squamous cell carcinoma. But, the resection specimen from this patient showed classic Warthin's tumor in addition to abundant areas of inflammation and squamous metaplasia. Metaplastic or infarcted Warthin's tumor in the salivary gland may be confused with false positive diagnosis of malignancy on FNAC. Therefore, cytopathologist should have adequate awareness of potential of erroneous diagnosis in FNAC of Warthin's tumor.

Fine Needle Aspiration Cytology of Extranodal Marginal Zone B cell Lymphoma with Abundant Plasma Cells and Eosinophilic Histiocytes in Parotid Gland.: Youngseok Lee, Jungsuk An, Yang Seok Chae, Bom Woo Yeom, Jong Sang Choi, Chul Hwan Kim; Korean J Cytopathol. 2007;18(2):165-169.

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Abstract PDF: The authors present the fine needle aspiration cytology (FNAC) cytologic findings of a case of extranodal marginal zone B cell lymphoma (MZBCL), which featured abundant plasma cells and eosinophilic histiocytes arising in both parotid glands. A 49-year-old female presented with palpable masses in both parotid glands. She had been suffering from systemic lupus erythematosus and rheumatoid arthritis. The lesions were evaluated by FNAC and smears showed a small number of clusters of oncocytic cells with abundant eosinophilic granular cytoplasm and small nuclei, intermixed with small to medium-sized lymphoid cells containing round to lobulated nuclei, which suggested Warthin's tumor. Some of lymphoid cells had a plasmacytoid appearance, and some scattered large cells contained a large amount of eosinophilic cytoplasm. Bilateral superficial parotidectomy was performed and a histopathologic study indicated MZBCL with abundant plasma cells, intermixed with eosinophilic histiocytes. The presence of oncocytic cells and a mixture of lymphoid and plasma cells indicates Warthin's tumor, but the cytologic features of a relatively monotonous small to medium-sized lymphoid infiltrate suggest the possibility of MZBCL in the clinical setting of an FNAC study performed on a patient suffering from a connective tissue disease.

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