Cytopathology : official journal of the British Society for Clinical Cytology · 2025
Fine-Needle Aspiration Cytology Diagnosis of Pleomorphic Adenoma With Spontaneous Infarction in the Salivary Gland: A Multicenter Retrospective Study.
СтатьяМногоцентровое исследованиеОбзорПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Wang Jie-Qiong, Li Ge, Wang Shao-Hua, Yang Bo, Liu Yun, Wan Yu, Huang Cong-Gai, Li Fan
Аннотация
OBJECTIVE: Spontaneous infarction in salivary gland pleomorphic adenoma (PA) diagnosed by fine-needle aspiration cytology (FNAC) is rarely documented. This study aims to systematically analyse and summarise its cytopathological characteristics to reduce the risk of misdiagnosis and enhance diagnostic precision.
METHODS: Five histopathologically confirmed cases (2017-2024) from two hospitals were retrospectively analysed. Clinical data, cytopathological findings and histopathology were reviewed, and causes of misdiagnosis were evaluated. Additionally, the cytopathological characteristics of salivary gland PA with spontaneous infarction were systematically analysed and comprehensively summarised, incorporating findings from relevant domestic and international literature.
RESULTS: Only two cases (40%) were correctly diagnosed as PA or PA with infarction. Two cases (40%) were misdiagnosed as suspicious of malignancy, and one case (20%) was inconclusive. The cytopathological features are as follows: Fine-needle aspiration (FNA) specimens often appear as milky-white or brownish paste, with or without small tissue fragments. Microscopically, there is a background of necrotic debris with numerous scattered pleomorphic small cells resembling 'naked nuclei', characterised by hyperchromatic and irregular nuclei, accompanied by atypical squamous metaplastic cells, 'ghost cells' and eosinophilic cells with non-atypical nuclei, with or without the presence of tumour-associated glandular epithelial cells, myoepithelial cells, lymphocytes, neutrophils or other inflammatory cells, while mucinous or chondroid stroma is rarely observed or absent, and no abnormal mitotic figures are identified.
CONCLUSION: The cytological features of PA with spontaneous infarction can mimic malignancy. Recognising these features is crucial to reducing diagnostic errors and guiding appropriate management.
METHODS: Five histopathologically confirmed cases (2017-2024) from two hospitals were retrospectively analysed. Clinical data, cytopathological findings and histopathology were reviewed, and causes of misdiagnosis were evaluated. Additionally, the cytopathological characteristics of salivary gland PA with spontaneous infarction were systematically analysed and comprehensively summarised, incorporating findings from relevant domestic and international literature.
RESULTS: Only two cases (40%) were correctly diagnosed as PA or PA with infarction. Two cases (40%) were misdiagnosed as suspicious of malignancy, and one case (20%) was inconclusive. The cytopathological features are as follows: Fine-needle aspiration (FNA) specimens often appear as milky-white or brownish paste, with or without small tissue fragments. Microscopically, there is a background of necrotic debris with numerous scattered pleomorphic small cells resembling 'naked nuclei', characterised by hyperchromatic and irregular nuclei, accompanied by atypical squamous metaplastic cells, 'ghost cells' and eosinophilic cells with non-atypical nuclei, with or without the presence of tumour-associated glandular epithelial cells, myoepithelial cells, lymphocytes, neutrophils or other inflammatory cells, while mucinous or chondroid stroma is rarely observed or absent, and no abnormal mitotic figures are identified.
CONCLUSION: The cytological features of PA with spontaneous infarction can mimic malignancy. Recognising these features is crucial to reducing diagnostic errors and guiding appropriate management.