Baloch ASC Webinar FNA of Salivary Glands · 2020. 5. 28. · The FNA might show the lump is due to an infection, a benign (non‐ cancerous) salivary tumor, or a salivary gland cancer

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Zubair Baloch, MD, PhD

Professor of Pathology & Laboratory Medicine

Algorithmic Approach to Everyday Salivary Gland Cytology Faculty Disclosure

X No, nothing to disclose

Yes, please specify:

Question #1

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Question #1The name “American Society of Cytology” was adapted in year?

Correct Answer ‐ #1

• The 1st Annual Scientific Meeting of the Inter‐Society Cytology Council was held in Philadelphia, Pennsylvania, November 19‐20, 1953, and the tradition has continued each succeeding year.

• At the 9th Annual Scientific Meeting held in Memphis in 1961, the name American Society of Cytology was adopted by unanimous vote of the membership.

Let’s Make Sense of Present & Predict Future

In Light of Past

“Study the past if you would define the future” ~Confucius

Fine‐Needle Aspiration Salivary Gland lesions

What We Know

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American Cancer Society Info for Patients w Salivary Gland Lumps

• Doctors may use FNA if they are not sure whether a lump is a salivary gland cancer. The FNA might show the lump is due to an infection, a benign (non‐cancerous) salivary tumor, or a salivary gland cancer. In some cases this type of biopsy can help a person avoid unnecessary surgery.

• An FNA biopsy is only helpful if enough cells are taken out to be able to tell for certain what a tumor is made of. But sometimes not enough cells are removed, or the biopsy is read as negative (normal) even when the tumor is cancer.

• If the doctor is not sure about the FNA results, a more extensive type of biopsy might be needed.

Advantages of Salivary Gland FNA

1.Differentiation of inflammatory from neoplastic disease1. Especially important in immunosuppressed

2.Culture for suspected infectious masses

3.Differentiation of benign from malignant disease

4.Differentiation of the specific tumor cell type

5.Determination of site of origin, primary vs. metastatic

6.Squamous cell carcinoma diagnosis: 1. Squamous cell carcinoma can be accurately diagnosed, and treatment can be planned based on fine‐needle

aspiration (FNA) findings.

2. A highly cellular muco‐epidermoid carcinoma may appear to be squamous cell carcinoma by fine‐needle aspiration (FNA) cytology.

3. This difference is purely academic and does not change the treatment.

Complications of Salivary Gland FNA• Needle track contamination by lesional cells:

– Rare complication despite thousands of fine‐needle aspirations (FNAs) performed worldwide.

– A positive correlation exists with number of passes and needle size.

• Local hemorrhage: – Major salivary glands are in close proximity to the great vessels of the head and neck, local hemorrhage due to piercing of these

vessels is possible but very unlikely.

– Hematoma formation can be prevented by applying firm pressure in the area of aspiration immediately after the procedure.

• Infection: – This risk is no greater than that of veni‐puncture and is closely correlated with the patient's immune status.

– Adherence to sterile techniques and cleaning the skin with alcohol minimizes this risk.

• Warthin tumor (papillary cystadenoma lymphomatosum or adenolymphoma) has a high predisposition for parotitis from FNA due to a combination of cystic spaces surrounded by oncocytic cells and poor blood supply.

• Syncope: – Some patients are prone to vasovagal reactions.

– Perform aspiration while the patient is lying down or sitting.

• Dissemination of the dislodged tumor cells through lymphatics and blood vessels: – Risk is certainly lower in fine‐needle aspiration (FNA) than in incisional biopsy.

Salivary Gland FNA

Literature Review

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Salivary Gland Lesions Reported in Cytology Literature

Inflammatory/ Non-neoplastic Benign Neoplasms Malignant

Sialadenitis (acute & chronic) Pleomorphic Adenoma Mucoepidermoid carcinoma

Sialadenosis Warthins Tumor Adenoid cystic carcinoma

Lymphoepithelial sialadenitis (LESA) Basal cell adenoma Acinic cell carcinoma

Lymphoepithelial cyst Monomorphic adenoma Basal cell adenocarcinoma

Mucocele Oncocytoma Carcinoma ex-pleomorphic adenoma

Reactive lymph node Myoepithelioma Epithelial-myoepithelial Carcinoma

Lipoma Salivary Duct Carcinoma

Secretory Carcinoma

Amyloidosis Lymphoma

The list of lesions diagnosed on FNA is still expanding to keep up with Surgical Pathology Literature

The Gold StandardHistologic Follow‐up

WHO Classification of Salivary Gland TumorsThen & Now

2017 WHO Classification of Salivary Gland Tumors1972 WHO Classification of Salivary Gland Tumors

Salivary Gland Tumors – Diagnostic Paradigm

MalignantBenign

Invasion Present• Macroscopic• Microscopic

• Perineural• Into surrounding normal parenchyma• Angioinvasion

Invasion Absent, BUT Benign Tumors can show• Multinodular and Irregular growth• Lack of encapsulation• Capsular violation • Outpouching into surrounding normal parenchyma• Vascular invasion?• Fatty metaplasia within the tumor mimicking invasion

into fat• Invasion absent but still Malignant

• Intraductal Carcinoma Cytologic Features of Malignancy• Marked Nuclear Pleomorphism• Atypical Mitoses• Tumor Necrosis

Benign Tumors (especially Pleomorphic Adenoma) can show / mimic Cytologic Features of Malignancy:• Increased Cellularity• Nuclear Pleomorphism• Mitoses• Infarction mistaken for Tumor Necrosis• Post FNA tumor necrosis• Atypical Architecture

But some Malignant Tumors May Not show Cytologic Features of Malignancy• Monotonous basaloid cells and low grade nuclear cytology of

“Adenoid Cystic Carcinoma”

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Histogenesis of Salivary Gland TumorsReason for Morphologic Heterogeneity

www. pocketdentistry.com Redder et al. Clin Can Invest J 2013;2:101‐105

Myoepithelial Cell Differentiation in in salivary gland tumors

Histogenesis of Salivary Gland TumorsReason for Morphologic Heterogeneity

DIAGNOSTIC REPORTING & MANAGEMENT

Salivary Gland FNA Literature Review

The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC): implied risk of malignancy and recommended clinical management

Diagnostic Category % ROM

(ROM range)

Management

Non‐Diagnostic c 25

(0‐67%)

Clinical and radiologic correlation/ repeat

FNAC

Non‐Neoplastic 10.2%

(0‐20%)

Clinical follow‐up and radiologic correlation

Atypia of Undetermined Significance (AUS) TBD Repeat FNAC or surgery

Neoplasm

i. Benign 3.4%

(0‐13%)

Surgery or

clinical follow‐up

i. Salivary Gland Neoplasm of Uncertain Malignant Potential (SUMP)e 37%

(0‐100%)

Suspicious for Malignancy 57%

(0‐100%)

Surgery

Malignant 92%

(57‐100%)

Surgery

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Milan System for Reporting Salivary Gland CytopathologyOnline Presence

Milan System for Reporting Salivary Gland CytopathologyOnline Presence, > 90 National & International Publications

Question #2

Question # 260‐year‐old man underwent FNA by palpation of a 1.5 cm mobile mass in left parotid gland.

This specimen should be classified as per “Milan System for Reporting Salivary Gland Cytopathology”

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Correct Answer for Question #2

• #3

Must know

Normal Salivary Gland Cytology

Normal Salivary Gland Histology

The Major Salivary Glands1. Parotid2. Submandibular3. Sublingual

The Minor Salivary Glands

• Acinus has acinar cells – Grape like clusters

• Myoepithelial cells constrict intercalated duct and squirt saliva into striated duct.

• Acinar epithelium secretes proteins and isotonic filtrate

Salivary Gland Histology

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Normal Salivary GlandHistology‐Cytology Correlation

Normal Salivary GlandHistology‐Cytology Correlation

Question #3

Question #3:The current name “American Society of Cytopathology” was adapted in year?

1. 1963

2. 1961

3. 1994

4. 1970

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• The current name, American Society of Cytopathology, was voted on during the 42nd Annual Scientific Meeting held in Chicago in 1994. This change was made to express the evolution of the profession.

Salivary Gland FNA Components

• Cells• Epithelial cells• Inflammatory cells

• Background• Stroma

• Basement membrane type material

• Mucous

• Proteinaceous

Cells

– Epithelial cells

Plasmacytoid

Basaloid

Oncocytic

Granular

Clear/Vacuolated

Background

– StromaFibrillary, solid

Relationship to cells

– MucousLook for intracytoplasmic mucin

– Proteinaceous

Salivary Gland Tumors: Pattern Recognition

Salivary Gland Tumors: Pattern Recognition

• Architecture – cytology-radiology correlation• Cystic (includes microcystic), solid, cribriform, papillary, acinar, tubular, trabecular

• Cell type• Ductal cells, myoepithelial cell and variants

• Stroma and basement membrane type material• Association with lesional cells

• Background• Mucin, inflammatory cells, macrophages

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60‐year‐old man with history of lung adenocarcinoma presented with a superficial left parotid mass.

The mass measured 1.5 cm and appeared solid and lobulated on ultrasound.

Cytology Diagnosis: Basaloid Neoplasm with Differential

60‐year‐old man with history of lung adenocarcinoma presented with a superficial left parotid mass. FNA Followed by Superficial Parotidectomy

Surgical Pathology Diagnosis: Pleomorphic Adenoma

Discussion: Tumors with:Matrix/Stroma & Basaloid Cells

1. Benign Mixed Tumor / Pleomorphic Adenoma

2. Adenoid Cystic Carcinoma

3. Basal cell adenoma

4. Basal cell adenocarcinoma

5. Polymorphous Adenocarcinoma (Location)

Benign Mixed Tumor / Pleomorphic Adenoma

Clinical Features

• Most common tumor of salivary glands in children and adults

• Two-thirds of parotid tumors

• 50% of all salivary gland tumors

• PE: Circumscribed; firm; rubbery

Cytomorphology

• Cells• Epithelial cells arranged in cohesive, honeycomb groups

• Myoepithelial cells arranged singly or loosely arranged groups

• Plasmacytoid, epitheloid, spindled or clear cells

• Chondromyxoid matrix• Fibrillar with frayed edges

• Embedded myoepithelial cells

• Surrounding individual tumor cells

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Many of BMT

Sharma G et al. Radiology 2011;259:471-478 2011 by Radiological Society of North America

The Classic Case of BMT

Parapharyngeal mass. Benign Mixed Tumor

Air‐dried smear

Alcohol fixed Pap‐stained smear ThinPrep® Cell Block

Variations on Classic “BMT”

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Sharma G et al. Radiology 2011;259:471-478

BMT w Cystic Change

Sharma G et al. Radiology 2011;259:471-478

BMT w Cystic Change

Cellular BMT with Increased Plasmacytoid Cells“SUMP” with a Differential Including Cellular BMT

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Pleomorphic Adenoma w Extensive Squamous & LipomatousMetaplasia

Pleomorphic AdenomaWith

Atypical Nuclei

1. Benign cellular atypia – Ancient change2. Atypia – Carcinoma ex-pleomorphic adenoma

55‐year old woman with 4.0 cm painless parotid mass, been present for 10+ years 55‐year old woman with 4.0 cm painless parotid mass, been present for 10+ years

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63‐year old man with 5.0 cm parotid mass, been present for 11+ years, currently enlarging rapidly. US shows solid & cystic mass.



Carcinoma ex‐pleomorphic adenoma

Pleomorphic AdenomaMimicking

Basaloid Tumors

The Story of Sampling A Heterogeneous Tumor

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Cellular BMT with Stromal Cores Mimicking Basaloid Neoplasms

Cellular BMT with Stromal Arrangements Mimicking Adenoid Cystic Carcinoma

. Look for spindle shaped and/or plasmacytoid cells

. Classic features of Pleomorphic Adenoma will be evident in other areas of the slide

. Process the entire specimen

. Immunostains can be helpful – Cell block

Adenoid Cystic Carcinoma (ADCC)

• 3rd most common malignancy

• Higher frequency in submandibular gland

• Poor long-term survival

Painful – due to invasion of the nerves

• Cytomorphology• Variably sized three dimensional Acellular Hyaline Matrix Globules surrounded by monotonous Basaloid Cells

• Cellular atypia – not frequent

D C Howlett, Br J of Radiology 2003

Hypoechoic tumorIrregular margins

Infiltration / Extension (into deep lobe of parotid gland)

Ultrasound Features of Adenoid Cystic Carcinoma (ADCC)

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ADCC – Classic Cytomorphology55‐year‐old man with history smoking and leukoplakia presented with a right sub‐mandibular mass slowly enlarging

for 5‐years. Patient complains of fullness without pain or paresthesia.

ThinPrep Preparation OnlyLightly staining Hyaline Globules

55‐year‐old man with history smoking and leukoplakia presented with a right sub‐mandibular mass slowly enlarging for 5‐years. Patient complains of fullness without pain or paresthesia.

Adenoid Cystic Carcinoma

ADCCa – ThinPrep SpecimenLook at the structure / shape of stroma

devoid of cells

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ADCCa – Thin-Prep Specimen. Look at the structure / shape of stroma devoid of cells Summary

Diagnostic Scenarios – Basaloid Cells

• Diagnosable as:• Neoplasm‐Benign: Pleomorphic Adenoma. Basal cell adenoma

• Malignant: ADCCa

• If morphology not typical:• Salivary gland neoplasm of uncertain malignant potential

• Basaloid features with differential

• Atypical nuclei

Differential Diagnosis of Tumors with Salivary Gland Neoplasm w Basaloid Features ‐ Based On Amount & Type of Stroma

1. FibrillaryPleomorphic Adenoma

Epithelial‐myoepithelial carcinomaBasal cell adenoma / Adenocarcinoma

2. HyalinizedBasal cell adenoma / Adenocarcinoma

Adenoid cystic carcinomaEpithelial‐myoepithelial carcinoma

Polymorphous adenocarcinoma (location)

3. Mixed or Other Types (globular structures) Adenoid cystic carcinomaPolymorphous adenocarcinoma

4. Scant to None Pleomorphic adenomaBasal cell adenoma (usually canalicular type)

MyoepitheliomaMyoepthelial carcinoma

Question #4

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Question # 445‐year‐old woman underwent ultrasound guided FNA of a 2.0 cm solid and painless right parotid gland mass.


Question # 245‐year‐old man underwent ultrasound guided FNA of a 2.0 cm solid and painless right parotid gland mass.


Question # 445‐year‐old woman underwent ultrasound guided FNA of a 2.0 cm solid and painless right parotid gland mass.


Correct Answer

• #1

26‐year‐old man with 2.8 cm ill‐defined mass bridging superficial and deep lobes of parotid gland

Malignant – Mucoepidermoid Carcinoma

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26‐year‐old man with 2.8 cm ill‐defined mass bridging superficial and deep lobes of parotid gland

Malignant – Mucoepidermoid Carcinoma

Mucoepidermoid Carcinoma - Classic Case

• Background• Mucinous (low grade tumors), extracellular mucin, easily detected strings of mucin• Lymphocytes

• Cells• Clear / foamy macrophage type cells (mucous glandular cells)• Ductal appearing intermediate cells. • Glandular cells, singly or gland formation.• Squamous cells. Lymphocytes

Mucoepidermoid Carcinoma – Not so Classic CasesThe Tumors Failed To Read the Atlas Low Cellularity Specimens

Mucoepidermoid Carcinoma – Not so Classic CasesThe Tumors Failed To Read the Atlas Low Cellularity Specimens

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Lymphocytes in Salivary Gland FNA Specimens

• Intraparotid LN• Lymphoepithelial cyst• Chronic Sialadenitis• Warthin Tumor

• Acinic cell carcinoma

• Mucoepidermoid Carcinoma

• Lymphoma

Low Grade Mucoepidermoid Carcinoma FNADifferential Diagnosis

• Benign tumors with focal mucinous or clear cell change• Pleomorphic adenoma

• Benign cysts

• Chronic sialadenitis with mucinous metaplasia

• Low grade salivary duct carcinoma

• Squamous cell carcinoma


• Carcinoma with clear cell features

Chronic Sialadenitis• Scant cellularity. Ductal epithelium (sheets & tubules). Paucity of acinar elements.

• Background debris & inflammation. Fragments of mesenchymal tissue.

• Squamous & mucinous Metaplasia. Cell atypia ?

23 Year‐old‐man with Right Parotid Mass

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Atypical cells Suspicious for Mucoepidermoid Carcinoma – Mucicarmine stain positive on the smearSurgical Pathology Diagnosis:

Chronic Sialadenitis


45 year‐old man with 2.5 cm submandibular/sub‐mental space mass Oncocytic Mucoepidermoid Carcinoma vs. Just Mucinous Cells in Warthin-Tumor

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Differential Diagnosis of Tumors with Oncocytic Features Based On Cytomorphologic Features

1. Background

• Cystic

• Mucinous

• Blood or Non‐specific

• Warthin Tumor, Cystadenoma

• Oncocytic Mucoepidermoid Carcinoma, Warthintumor w mucinous metaplasia?

• Oncocytoma, Pleomorphic Adenoma

2. Cytoplasm

‐ not so dense but variably vacuolated

• Acinic Cell Carcinoma• Secretory Carcinoma (MASC)

• Metastatic Renal Cell Carcinoma

3. Nuclear Atypia • Salivary Duct Carcinoma• High Grade Mucoepidermoid Carcinoma

• Metastatic Renal Cell Carcinoma

Question #5

Question #5In which year the cytotechnologists were voted onto the ASC executive board?


• The cytotechnologist role in the ASC has evolved over the years. Originally, the cytotechnologists were welcomed into the Society as Associate members in 1954.

• In 1981, a new category was established setting criteria for a voting cytotechnologist in the Society. That same year, three cytotechnologists were voted onto the Executive Board.

• Later in 1995, the membership category was changed to Cytotechnologists members and Voting Cytotechnologists members.

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50 year old woman with a slow growing right parotid mass, present size 5.0 cm

Malignant: Acinic Cell Carcinoma

50 year old woman with a slow growing right parotid mass, present size 5.0 cm

Malignant: Acinic Cell Carcinoma

Acinic Cell Carcinoma – Radiologic FeaturesLi et al. Eur J Radiol 2014;83:1152‐1156

Irregular bordersWell‐definedHypoechoic

Plain CT: Regular defined homogeneous lesionContrast: Moderate homogeneous enhancement

Acinic Cell Carcinoma – Cytomorphologic Features

1. Sheets of large cells with abundant foamy vacuolated and granular cytoplasm2. Eccentrically placed nuclei with small, inconspicuous nucleoli, naked nuclei in the background (delicate cytoplasm)

3. Lymphocytes

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Acinic Cell Carcinoma –Differentiate from Benign Acinar Tissue (BAT)

BAT – Low power “Rosette” pattern or “Clustered Ball‐like” strructures Acinic Cell CarcinomaDifferential Diagnosis

• Granular cytoplasm• Oncocytic / Oncocytoid Tumors

• Secretory Carcinoma

• Clear or vacuolated cytoplasm• Myoepithelial differentiation

• Metastatic tumors

• Granular Cytoplasm + Lymphocytes• Warthin Tumor

Warthin Tumor

• Primarily occurs within parotid gland• Second most common salivary gland neoplasm – 5‐10%

• Believed to originate from salivary duct remnants entrapped within glandular lymphoid tissue

• Clinical features:• 50‐79 year‐old

• Common in men

• Bilateral

• PET and TC‐99 positive

Cyto-morphology: Lymphocytes & Oncocytes• Mixed population of lymphocytes in the background and intimately associated

with oncocytic cells• Background debris ( grossly mobile oil consistency)• Rarely Mucous cells (think of oncocytic mucoepidermoid carcinoma)

Warthin TumorCyto-morphology: Lymphocytes & Oncocytes

• Mixed population of lymphocytes in the background and intimately associated with oncocytic cells

• Background debris ( grossly mobile oil consistency)

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Warthin TumorCyto-morphology: Lymphocytes & Oncocytes

• Mixed population of lymphocytes in the background and intimately associated with oncocytic cells• Background debris ( grossly mobile oil consistency)

45-old-woman with 2.5 cm right parotid mass

Oncocytic Neoplasm vs. Secretory Carcinoma

45-old-woman with 2.5 cm right parotid mass

Oncocytoma

E

F

45‐year‐old man with right parotid gland mass

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E

F

45‐year‐old man with right parotid gland mass

FISH ‐ ETV6 Rearrangement

Recent Case: 71‐year old with <1.0 cm left submandibular gland mass


MAML2 FISH +ve, DOG‐1 negative

Poster # 1294 –USCAP 2019. Bundele et al. Mucoacinar carcinoma: A rare intercalated duct/acinar variant of mucoepidermoid carcinoma, hybrid tumor or distinct entity


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Question #6

Question # 665‐year‐old man underwent ultrasound guided FNA of a 4.0 cm cystic and solid right parotid gland mass. This specimen should be classified as per “Milan System for Reporting Salivary Gland Cytopathology”

Question # 665‐year‐old man underwent ultrasound guided FNA of a 4.0 cm cystic and solid right parotid gland mass. This specimen should be classified as per “Milan System for Reporting Salivary Gland Cytopathology” Correct Answer

• #4

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Ancillary Studies

Special Stains and Immunostains

Molecular Targets

PanCK p63 &

p40

SOX10 S100 DOG1 Mammoglobin Androgen

Receptor

GATA3 CD117 PLAG1

Tumor Type

Pleomorphic Adenoma + + + + ‐ ‐ ‐ v v +

Basal Cell

Adenoma/Adenoca

+ + + + ‐ ‐ ‐ v v v

Mucoepidermoid Ca + + +/‐ ‐ ‐ ‐ ‐ v v ‐

Acinic Cell Ca + ‐ + ‐ + ‐ ‐ ‐ ‐ ‐

Secretory Ca (MASC) + ‐ + + ‐ + ‐ + (n) ‐ ‐

Adenoid Cystic Ca + + + + + ‐ ‐ ‐ +

(luminal)

‐

Oncocytoma + + ‐ ‐ ? ‐ ‐ ‐ ? ?

Ancillary Studies - Immunohistochemistry

Caution should be applied when using these in cytology preparations ‐ validation

Ancillary Studies - Molecular Targets

• Mucoepidermoid Carcinoma

• CRTC1‐MAML2 ‐ t(11;19)(q21;p13)

• CRTC3‐MAML2 ‐ t(11;15)(q21;q26)

Adenoid Cystic Carcinoma• MYB‐NFIB‐T(6:9) ‐ t(6;9)(q22‐23;p23‐24)rarely t(8;9)

• Pleomorphic Adenoma & CA ex PA

• PLAG1 ‐ t(3;8)(p21;112), t(5;8)(p13;q12)

• HMGA2‐t(3:12) ‐ t(3;12)(p14.2;q14‐5), ins(9;12)(p23;q12‐15)

• Secretory Carcinoma (MASC)ETV6‐NKRT: t(12:15)(p13q25)

• Acinic Cell CA

mTOR Pathway, PTEN, BRAF, NF1

• Polymorphous Adenocarcinoma

• PRKD1 E710D

Summary

My Two Cents

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Diagnosing Salivary Gland Lesions on Fine‐needle Aspiration Cytology

• Clinical History

• Radiologic features (if available)

• Architectural pattern

• Cellular elements & their distribution• Background

• Differential diagnosis

• If specific diagnosis cannot be provided – Grouping based on: • Cellular elements – everything counts (background, cell, stroma, other)

• Differential

•Warthin’s Tumor

• Cystadenocarcinoma

•Mucoepidermoid carcinoma


Cystic• Acinic cell carcinoma

• Polymorphous adenocarcinoma

•Mucoepidermoid carcinoma

• Secretory CarcinomaMicrocystic

• Pleomorphic adenoma

• Adenoid cystic carcinoma

• Salivary duct carcinoma


• Cribriform adenocarcinoma

Cribriform• Pleomorphic adenoma

• Adenoid cystic carcinoma


• Epithelial‐myoepithelial carcinoma

• Cystadenoma / cystadenocarcinoma

• Salivary duct carcinoma

Tubular

•Warthin’s Tumor

• Cystadenocarcinoma


• Adenocarcinoma, NOSPapillary

Tumor Grouping Based on Architectural Pattern

Basaloid Neoplasm

• Pleomorphic adenoma

• Basal cell adenoma

• Adenoid cystic Ca*

• Polymorphous adenocarcinoma*

• Basal cell adenocarcinoma

Oncocytic / OncocytoidNeoplasm

• Warthin Tumor

• Oncocytoma

• Cystadenoma


• Secretory carcinoma

• Oncocytic carcinoma

• Sebaceous adenocarcinoma (rare)

Neoplasm with

Clear Cell Features

• Clear cell carcinoma*

• Epithelial myoepithelialcarcinoma


• Metastatic tumor

• Clear cell oncocytoma(rare)

• Sebaceous adenocarcinoma (rare)

Tumor Grouping Based on Cellular Elements

*Tumor location Salivary Gland Fine Needle Aspiration Reporting – Milan System

Benign Neoplasm SUMP Suspicious‐Malignancy Malignant

BMT/PA BMT/PA

Warthin T Acinic Cell Ca

Adenoid Cystic Ca

Basaloid Neoplasm

Secretory Carcinoma

Susp‐MEC

BMT/PA w Atypia

Oncocytic / Oncocytoid Neoplasm

Necrotic Tumor Susp SCCA

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SUMMARIZING TO …Based on:

Morphologic heterogeneity

Literature Review &

Ever expanding list of salivary gland lesions

Milan System for Reporting Salivary Gland Cytopathology

Documents

Baloch ASC Webinar FNA of Salivary Glands · 2020. 5. 28. · The FNA might show the lump is due to an infection, a benign (non‐ cancerous) salivary tumor, or a salivary gland cancer