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A challenging head and neck FNA

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楼主 发表于 2009-06-05 03:31|举报|关注(0)
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A 62-year-old female with a nasolabial sulcus mass (upper lip) and an intra-oral FNA was done. I have four photos, all with Pap stain. I am interested in what's your differential diagnosis?
  • A challenging head and neck FNA图1
    图1
  • A challenging head and neck FNA图2
    图2
  • A challenging head and neck FNA图3
    图3
  • A challenging head and neck FNA图4
    图4
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1 楼    发表于2009-07-01 22:39:00举报|引用
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 感谢月新的翻译和评论!

 

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2 楼    发表于2009-06-30 23:24:00举报|引用
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 I feel that this case is very difficult and I would like to summarize it:

 1) Polymorphous low-grade adenocarcinoma (PLGA) is found almost exclusively in minor salivary gland. It is a low-grade malignancy with generally good prognosis. It is commonly present in patients aged 50-70 year-old with female affected twice as frequently as men (our patient is a 61-year-old woman).

2) PLGA is cytologically uniform, but architecturally diverse: it can be lobular, solid nests, cribriform, or papillary. It is usually infiltrative with perineural invasion. The bluish stroma in the background is typical and it is different from the chondroid myxoid stroma found in pleomorphic adenoma (PA);

3) The differential diagnosis of PLGA mainly includes PA and adenoid cystic carcinoma (ACC). Because PLGA has diverse architectural appearance, it is very difficult to diagnose on FNA and most of times are not possible even on small excisional biopsy. This patient had a small excisional biopsy almost 10 years ago and was called PA, but we get the outside slides and it is almost identical to the current resection specimen, also showed perineural invasion.

4) This case brought a very important concept that I would like to share with our chinese pathologists on ipathology. Salivary gland FNA can be very difficult, if a FNA sample does not fit perfectly in a disease category, I would have no hesitation to issue the report with "Atypical cells present" and a comment recommend excision. In this case, on the FNA, I don't see the typical chondroid-myxoid stroma, so I would not just sign out the case as "pleomorphic adenoma".

5) To be a good cytopathologist, we have to know our limitation and the clinical management, as most of the salivary gland tumors will be clinically taken out surgically anyway except some Warthin tumors, metastatic tumors, and lymphoma. So, if you can tell the clinician that this is most likely a low-grade salivary gland neoplasm (not Warthin tumor or lymphoma or metastatic tumor), the clinical management usually is similar.

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3 楼    发表于2009-06-19 22:38:00举报|引用
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 Finally, 坦然TR got it right. It is polymorphous low grade adenocarcinoma (PLGA). What's the usual clinical presentation and prognosis of PLGA?
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4 楼    发表于2009-06-18 21:38:00举报|引用
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 I don't think that this is 浸润性筛状癌  or 低度恶性筛状囊腺癌. Think again! What is the characteristics of the stroma, which can be confused with pleomorphic adenoma?
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5 楼    发表于2009-06-17 22:30:00举报|引用
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 You got the "腺癌" right, but it is not 囊腺癌, this 腺癌 is almost exclusively occur in minor salivary glands. Please take a look at the WHO classification for salivary gland tumor and find the answer.
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6 楼    发表于2009-06-16 22:03:00举报|引用
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 I have posted the histology for 2 days. What's the diagnosis on histology? Anyone who is good at salivary gland surgical pathology?
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7 楼    发表于2009-06-12 23:14:00举报|引用
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Here is the histology of the resection. Thanks!

  • 图1
  • 图2
  • 图3
  • 图4
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8 楼    发表于2009-06-10 21:03:00举报|引用
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 I do NOT see the typical fibrilary chondroid-myxoid stroma in this case, so I could not call this case pleomorphic adenoma. I decided to sign out as " a low grade epithelial neoplasm", recommend excision. It turned out to be a very good case of ????, Can you guess?

 I have the surgical resection of this tumor and will post soon.

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9 楼    发表于2009-06-08 21:09:00举报|引用
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本帖最后由 于 2009-06-10 12:49:00 编辑 I like your guy's differential diagnosis. This patient had the same tumor 10 years ago and was diagnosed "pleomorphic adenoma" in an outside institution. Now, it appears that it has recurred. I am taking two more photos. Is this time "pleomorphic adenoma" again or something else? (译文:我很欣赏大家的鉴别诊断,患者10年前在外院诊断为多形性腺瘤,现在似乎是复发,我又提供两幅图,,这次它是其它肿瘤还是混合瘤复发?)
  • 图1
  • 图2
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