parotid swelling , with cytopathology suggestive of adenoid cyst carcinoma

1. Cases:
12 FNA- 7
Parotid
Preparation –2 pap QD
Clinical: male , 52 years. Parotic swelling ,
Screened and reported by: Sejojo Phaaroe. M.T; C.T (I.A.C); M.I.B.M.S
Cytology:
This is a sanguineous and a mucinous back grounded smear with some cells in glandular groups, 3
dimensional syncytia, and rosettes configurations are present. There is marked cellular
pleomorphism , anisonucleosis, nuclear noses, pulled out tad poled and indentations. Cells exhibit
salt and pepper coarse chromatin granulation - slide 5682 ( red and green colour)
5684
Cell syncytia, cell pleomorphism, noses, and macro-nucleation seen.
Bi- Nucleation , , mitotic figures with promonent nucleoli seen .
5658
Mixed mesenchymal cells with pulled out cells, some cells are single lying, the size of the single lying
lymphocyte.
Diagnosis: Adenoid cystic carcinoma
Final diagnosis: Malignant:
Screened by: Sejojo Phaaroe. MT; CT (IAC); MIBMS

2. Discussions
The major salivary glands are the parotid glands, submandibular glands and sublingual
glands. There are also a large number (600-1,000) of minor salivary glands widely distributed
throughout the oral mucosa, palate, uvula, floor of the mouth, posterior tongue, retromolar
and peritonsillar area, pharynx, larynx and paranasal sinuses. Tumours affecting salivary
glands may be benign or malignant and are diverse in their pathology.
 80% of salivary gland neoplasms arise in the parotid glands, 10-15% in the
submandibular glands and the remainder in the sublingual and minor salivary glands.1
 About 80% of parotid neoplasms are benign but the relative proportion of malignancy
increases in smaller glands. About half of submandibular gland neoplasms and most
sublingual and minor salivary gland tumours are malignant.
Classification
Malignant tumours
The malignant tumours most commonly affecting the major salivary glands are
mucoepidermoid carcinoma, acinic cell carcinoma and adenoid cystic carcinomas. Among
the minor salivary glands, adenoid cystic carcinoma is the most common. Malignant tumours
are designated high-grade or low-grade dependent on their histology.
 High-grade:
o Mucoepidermoid carcinoma (grade III): mucoepidermoid carcinoma is the
most common malignancy of the parotid gland and is the second most
common of the submandibular gland (after adenoid cystic carcinoma). It
represents about 8% of all parotid tumours.
o Adenocarcinoma - poorly differentiated carcinoma and anaplastic carcinoma;
represents 2-3% of salivary tumours.
o Squamous cell carcinoma.
o Malignant mixed tumours.
o Adenoid cystic carcinoma.
 Low-grade:
o Acinic cell tumours: represent 1% of all salivary gland neoplasms. 95% arise
in the parotid gland.
o Mucoepidermoid carcinoma (grades I or II).
Benign tumours
 Pleomorphic adenoma (most common): also called benign mixed tumour, is the most
common tumour of the parotid gland and causes over a third of submandibular
tumours. They are slow-growing and asymptomatic.
 Warthin's tumour: second most common benign salivary gland neoplasm,
representing about 6-10% of all parotid tumours. They rarely occur in other glands
and 12% are bilateral. They present most often in the 6th decade in women and the
7th decade in men.2
 Rarities including oncocytomas and monomorphic adenomas.

3. Regional metastases from skin or mucosal malignancies may present as salivary gland
masses. 1-3% of patients with cutaneous squamous cell carcinoma of the head and neck
experience metastatic spread to the parotid-area lymph nodes. Lymphomas may occasionally
present in a salivary gland.3 In children, most parotid tumours are benign and are
haemangiomas.4
Epidemiology1
 Neoplasms of salivary glands have an incidence of about 1 to 2 per 100,000 per
annum in England and Wales, with about 470 new cases diagnosed every year.5
 They are fewer than 1% of all cancers and 3-6% of all tumours of the head and neck.
 Tumours are most common in the 6th decade of life.
 Malignancy typically presents after age 60, whilst benign lesions usually occur after
age 40.
 Benign tumours are more common in women, but malignant tumours have an equal
sex distribution.
 Certain ethnic groups, e.g. Inuit populations, have a higher rate of salivary gland
tumours which is maintained even after migration to a low incidence area. The
responsible environmental or genetic factors are unknown.6
Risk factors
 Radiation to the neck increases the risk of malignancy of salivary glands with a 15- to
20-year latency.7
 Smoking is an important risk factor for the development of Warthin's tumours but its
relationship to malignant parotid tumours is less clear.8 Warthin's tumours are eight
times more common in smokers compared with non-smokers.
 Some studies have suggested an association between high use of mobile phones and
an increased risk of benign and malignant parotid tumours9, although others have
found no evidence of such a relationship.10
Presentation1
In England and Wales, about 13% patients with salivary gland cancer present with early
disease, 17% with locally advanced, 7% with lymph node involvement and 28% with
metastatic disease (and unknown staging in 35%).5
Symptoms
 Most salivary gland neoplasms are a slowly enlarging painless mass:
o Parotid neoplasms most commonly occur in the tail of the gland as a discrete
mass in an otherwise normal gland.
o Submandibular neoplasms often appear with diffuse enlargement of the gland.
o Sublingual tumours produce a palpable fullness in the floor of the mouth.
o Minor salivary gland tumours vary according on the site of origin - painless
masses on the palate or floor of the mouth are the most common form but
laryngeal salivary gland tumours can produce airway obstruction, dysphagia,

4. or hoarseness. In the nasal cavity or paranasal sinus they cause nasal
obstruction or sinusitis.
 Facial palsy with a salivary gland mass indicates malignancy.
 Pain can occur with both benign and malignant tumours. Pain may arise from
suppuration or haemorrhage into a mass or from infiltration of adjacent tissue.
Signs
Use bimanual palpation of the lateral pharyngeal wall for deep lobe parotid tumours and the
extent of submandibular and sublingual masses.
 Clinical features of a salivary gland mass suggestive of malignancy are:
o Hardness.
o Fixation.
o Tenderness.
o Infiltration of surrounding structures, e.g. facial nerve, local lymph nodes.
o Overlying skin ulceration.
Cranial nerve palsy