You answered: Pleomorphic adenoma with mucoid stroma
Sorry, that is INCORRECT
The correct diagnosis is: Low-grade mucoepidermoid carcinoma
CYTOPATHOLOGY:
- The specimen consists of clusters of intermediate cells mixed with mildly atypical mucous-producing cells in a background containing abundant mucous
- Consistent with low-grade mucoepidermoid carcinoma
DISCUSSION:
- The biopsy reveals numerous mucous-secreting cells with focal sheets of intermediate cells
- Marked cystic change and a dense collagenous stroma were also identified in areas of the tumour
- Low-grade MEC is one of the most common salivary gland malignancies occurring in all age groups
- It is usually well-demarcated, slow-growing and painless
- Coexistence of intermediate cells showing epidermoid differentiation and mucin-secreting cells is required for definitive diagnosis in cytologic preparations
- Abundant mucous may suggest salivary duct cyst but the presence of mucous/goblet cells favours mucoepidermoid carcinoma that may rarely be rich in oncocytes
- Pleomorphic adenoma may have mucous and squamous metaplasia but it is usually focal. Chondromyxoid stroma best identified on Giemsa stain and free lying myoepithelial cells suggest pleomorphic adenoma
- Low grade tumours have a predominance of uni- or multilocular cystic mucinous components versus high grade tumours that are mainly solid with intermediate and squamous cells, high grade nuclear features and minimal mucous differentiation.
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Histology
References:
Orell SR, Sterrett GF, Whitaker D. Fine Needle Aspiration Cytology, 4th ed. Elsevier Churchill Livingstone; 2005. pp67-69.
Elhosseiny A. Salivary Glands in Koss' Diagnostic Cytology and Its Histopathologic Bases, 5th ed. Lippincott Williams & Wilkins; 2006pp 1243-1246.
