Fine-needle aspiration of normal tissue from enlarged salivary glands: sialosis or missed target?

Salivary gland enlargement by hypertrophy of normal-appearing parotid or submaxillary tissue is known as sialosis. It can be idiopathic, or may be associated with malnutrition, diabetes, bulimia, or alcoholism. When normal tissue is aspirated from an enlarged gland, one is tempted to diagnosed sialosis. We performed 26 such aspirates over a 5-yr period. In all cases, the cytology featured abundant acinar and ductal tissue in a clean (noninflammatory) background. Six cases were excluded when the records showed no return visits to the clinic. The remaining 20 patients included 9 men and 11 women, aged 24-92 yr (median 56), who harbored 12 parotid (2 bilateral) and 8 unilateral submaxillary enlargements. Clinical findings included ethanol abuse (2), diabetes (1), and previously diagnosed head and neck carcinoma (3). In six patients, the duration of the mass was described as months or years. Excision (6), reaspiration (3), radiographic evaluation (2), and clinical follow-up of patients not evaluated by other means (9 cases with median follow-up of 6 months) revealed no malignancies. One excised gland contained a pleomorphic adenoma measuring 0.5 cm in diameter. This had been diagnosed by repeat fine-needle aspiration (FNA) prior to surgery. We suggest that sialosis is a meaningful FNA diagnosis in patients who are carefully examined, skillfully aspirated, and reasonably followed.