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Zahra Maleki - One of the best experts on this subject based on the ideXlab platform.
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cytomorphology and diagnostic pitfalls of sebaceous and nonsebaceous Salivary Gland lymphadenoma a multi institutional study
2021Co-Authors: Kartik Viswanathan, Zahra Maleki, Liron Pantanowitz, Richard Cantley, William C FaquinAbstract:BACKGROUND Salivary Gland lymphadenoma (LAD) is a rare benign Neoplasm comprising sebaceous (SLAD) and nonsebaceous (NSLAD) types. Despite established histologic criteria, limited data on cytomorphology, tumor heterogeneity, and overlap with other entities make the diagnosis of LAD by fine needle aspiration (FNA) challenging. We describe a multi-institutional cohort of 14 LADs with cytology, clinical, radiologic, and histopathologic data. METHODS Our cohort included nine SLAD and five NSLAD with corresponding histopathology. Mean patient age and M:F ratio were 60.4 years (range 45-86 years) and 1:2 for SLADs and 57.4 years (range 42-80 years) and 1:1.5 for NSLADs, respectively. One NSLAD patient had a germline predisposition for Cowden syndrome. Glass slides and whole slide images of air-dried Diff-Quik (DQ), alcohol-stained Papanicolaou smears (Pap) and cellblocks were reviewed for key cytomorphologic findings. RESULTS FNAs from SLAD and NSLADs demonstrated vacuolated and basaloid epithelial clusters within a lymphoid background. Vacuolated cells from SLAD showed sebaceous cells with microvesicular cytoplasm indenting a central nucleus. Vacuolated cells from NSLAD were columnar with eccentric nuclei, corresponding to abluminal Glandular cells. SLADs were classified using the Milan System for Reporting Salivary Gland Cytopathology as nondiagnostic (11.1%), nonneoplastic (44.4%), atypia of uncertain significance (AUS) (22.2%), and Salivary Gland Neoplasm of uncertain malignant potential (SUMP) (22.2%). NSLADs were classified as AUS (40%), SUMP (40%) and Benign Neoplasm (20%). CONCLUSION Although rare, knowing the cytologic features of Salivary LAD is important to avoid diagnostic pitfalls. Vacuolated cells can be prominent in both SLAD and NSLAD aspirates. Diagnostic issues arise from insufficient sampling of all tumor components leading to marked variation in diagnostic classification of LAD.
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risk of malignancy associated with cytomorphology subtypes in the Salivary Gland Neoplasm of uncertain malignant potential sump category in the milan system a bi institutional study
2019Co-Authors: Daniel An, Sayanan Chowsilpa, Holly Lose, Xiao Huang, Ritu Nayar, Zahra MalekiAbstract:BACKGROUND Salivary Gland Neoplasm of uncertain malignant potential (SUMP) is a diagnostic category in the Milan System for Reporting Salivary Gland Cytopathology. The objective of this study was to assess the risk of Neoplasm (RON) and the risk of malignancy (ROM) in SUMP cases by evaluating them based on their prominent cytomorphology. METHODS The pathology databases were searched for cases of fine-needle aspiration-diagnosed SUMP at The Johns Hopkins Hospital and Northwestern University from 2013 to 2018. Only cytopathology cases diagnosed as SUMP that had available surgical follow-up were included. RESULTS Sixty-five patients with SUMP were identified, including 31 men and 34 women who ranged in age from 15 to 87 years (mean age, 55.2 years). Sixty-five cases had histologic follow-up, including 13 (20%) with basaloid features, 13 (20%) with oncocytic features, and 39 (60%) with unspecified features. No cases with clear cell features were found. Overall, the RON in the SUMP category was 95.4% (62 of 65 cases), and the ROM was 33.8% (22 of 65 cases). The RON in SUMPs with basaloid, oncocytic, and unspecified subtypes was 92.3%, 100%, and 94.9%, respectively, whereas the ROM was 38.5%, 7.7%, and 41%, respectively. The most common benign Neoplasm was pleomorphic adenoma (23.1%), whereas mucoepidermoid carcinoma (9.2%) was the most common malignant Neoplasm. CONCLUSIONS This study shows that the ROM differs significantly based on cytomorphology subtypes, whereas the overall ROM is approximately the same as the target rate in the Milan System for Reporting Salivary Gland Cytopathology. Moreover, the RON remains high in the SUMP category among different cytomorphology subtypes. Adequate sampling, immunohistochemical staining, and familiarity with metaplastic and reactive changes may improve the diagnosis.
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application of the milan system for reporting submandibular Gland cytopathology an international multi institutional study
2019Co-Authors: Zahra Maleki, Khurram Shafique, Sharon Song, Kartik Viswanathan, Austin Wiles, Zubair W Baloch, Rema Rao, Holly Lefler, Aisha Fatima, He WangAbstract:Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6-tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular Gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular Gland FNAs. Methods Submandibular Gland FNA cytology specimens from 15 international institutions (2013-2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign Neoplasm, Salivary Gland Neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow-up was performed, and the ROM was calculated for each MSRSGC diagnostic category. Results The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%-50%); nonneoplastic, 24.2% (9.1%-53.6%); AUS, 6.7% (0%-14.3%); benign Neoplasm, 18.3% (0%-52.5%); SUMP, 12% (0%-37.7%); SM, 3.5% (0%-12.5%); and malignant, 13.9% (2%-31.3%). The histopathologic follow-up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign Neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. Conclusions This multi-institutional study shows that the ROM of each MSRSGC category for submandibular Gland FNA is similar to that reported for parotid Gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular Gland FNA.
Kartik Viswanathan - One of the best experts on this subject based on the ideXlab platform.
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cytomorphology and diagnostic pitfalls of sebaceous and nonsebaceous Salivary Gland lymphadenoma a multi institutional study
2021Co-Authors: Kartik Viswanathan, Zahra Maleki, Liron Pantanowitz, Richard Cantley, William C FaquinAbstract:BACKGROUND Salivary Gland lymphadenoma (LAD) is a rare benign Neoplasm comprising sebaceous (SLAD) and nonsebaceous (NSLAD) types. Despite established histologic criteria, limited data on cytomorphology, tumor heterogeneity, and overlap with other entities make the diagnosis of LAD by fine needle aspiration (FNA) challenging. We describe a multi-institutional cohort of 14 LADs with cytology, clinical, radiologic, and histopathologic data. METHODS Our cohort included nine SLAD and five NSLAD with corresponding histopathology. Mean patient age and M:F ratio were 60.4 years (range 45-86 years) and 1:2 for SLADs and 57.4 years (range 42-80 years) and 1:1.5 for NSLADs, respectively. One NSLAD patient had a germline predisposition for Cowden syndrome. Glass slides and whole slide images of air-dried Diff-Quik (DQ), alcohol-stained Papanicolaou smears (Pap) and cellblocks were reviewed for key cytomorphologic findings. RESULTS FNAs from SLAD and NSLADs demonstrated vacuolated and basaloid epithelial clusters within a lymphoid background. Vacuolated cells from SLAD showed sebaceous cells with microvesicular cytoplasm indenting a central nucleus. Vacuolated cells from NSLAD were columnar with eccentric nuclei, corresponding to abluminal Glandular cells. SLADs were classified using the Milan System for Reporting Salivary Gland Cytopathology as nondiagnostic (11.1%), nonneoplastic (44.4%), atypia of uncertain significance (AUS) (22.2%), and Salivary Gland Neoplasm of uncertain malignant potential (SUMP) (22.2%). NSLADs were classified as AUS (40%), SUMP (40%) and Benign Neoplasm (20%). CONCLUSION Although rare, knowing the cytologic features of Salivary LAD is important to avoid diagnostic pitfalls. Vacuolated cells can be prominent in both SLAD and NSLAD aspirates. Diagnostic issues arise from insufficient sampling of all tumor components leading to marked variation in diagnostic classification of LAD.
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assessing the diagnostic accuracy for pleomorphic adenoma and warthin tumor by employing the milan system for reporting Salivary Gland cytopathology an international multi institutional study
2020Co-Authors: Derek B Allison, Alexander P Smith, James Adam Miller, Khurram Shafique, Sharon Song, Kartik Viswanathan, Elizabeth Eykman, Rema A Rao, Austin Wiles, Guliz A BarkanAbstract:Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has established distinct diagnostic categories for reporting cytopathological findings, and each is associated with a defined risk of malignancy (ROM). However, the ROM is applied at the overall category level and is not specific for particular morphological entities within a category. Here, the diagnostic performance of the MSRSGC for pleomorphic adenoma (PA) and Warthin tumor (WT) is reported. Methods The pathology archives of 11 institutions from 4 countries were retrospectively searched to identify all Salivary Gland fine-needle aspiration (FNA) biopsies with a differential or definitive diagnosis of PA or WT and all resection specimens with a diagnosis of PA or WT; only paired cases were included. All FNA diagnoses were retrospectively classified according to the MSRSGC. Results A total of 1250 cases met the inclusion criteria, and they included 898 PA cases and 352 WT cases. The ROM in the benign Neoplasm category was 3.0% and 1.3% for cases with a differential or definitive diagnosis of PA and WT, respectively. The ROM in the Salivary Gland Neoplasm with uncertain malignant potential (SUMP) category was 2.7% and 18.8% for PA and WT, respectively (P = .0277). The diagnostic accuracy for PA and WT was 95.1% and 96.1%, respectively. Conclusions The diagnostic accuracy for PA and WT on FNA is high. Furthermore, these findings highlight the difference in the ROMs associated with 2 specific differential diagnoses in the SUMP category: basaloid Neoplasms and oncocytoid Neoplasms.
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mucoepidermoid carcinoma acinic cell carcinoma and adenoid cystic carcinoma on fine needle aspiration biopsy and the milan system an international multi institutional study
2019Co-Authors: James Adam Miller, Khurram Shafique, Sharon Song, Kartik Viswanathan, Elizabeth Eykman, Austin Wiles, Daniel An, Andrew S Field, Guido Fadda, Guliz A BarkanAbstract:Background We evaluated the diagnostic accuracy (DA), risk of Neoplasm (RON), and risk of malignancy (ROM) for the commonly encountered malignant Salivary Gland tumors mucoepidermoid carcinoma (MECa), acinic cell carcinoma (ACCa), and adenoid cystic carcinoma (ADCa) applying The Milan System for Reporting Salivary Gland Cytology (MSRSGC). Materials and methods The cytology archives from 2007 to 2017 of 9 academic institutions were searched for Salivary Gland FNAs for the following key words mentioned either in the principal and/or differential diagnosis: MEC, ACCa, and ADCa. The original cytology diagnosis was retrospectively classified according to the MSRSGC. Patient demographics, biopsy site, and available surgical follow-up were recorded. The final analysis included only cases with surgical follow-up. Results A total of 212 Salivary Gland FNAs were included. Based on retrospective reclassification according to MSRSGC, 97 of 212 (46%) FNA cases carried a diagnosis of malignancy specific for either MECa, ACCa, or ADCa. In the remaining 115 cases, 24 of 212 (11%) were reclassified as suspicious for malignancy (SM) and 91 of 212 (43%) as Salivary Gland Neoplasm of uncertain malignant potential (SUMP). The DA for MECa, ACCa, and ADCa was 78.7%, 75% and 89%, respectively. The RON was 100% for all 3 tumors and the ROM was 93.6% for MECa, 96.8% for ACCa, and 94.4% for ADCa. Conclusions The DA of 78.7% for MECa, 75% for ACCa, and 89% for ADCa is reasonable in FNA specimens. Although the management of definitive cases of malignancy remains unchanged, the MSRSGC provides a ROM for SM and SUMP categories, which can improve patient management.
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application of the milan system for reporting submandibular Gland cytopathology an international multi institutional study
2019Co-Authors: Zahra Maleki, Khurram Shafique, Sharon Song, Kartik Viswanathan, Austin Wiles, Zubair W Baloch, Rema Rao, Holly Lefler, Aisha Fatima, He WangAbstract:Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a 6-tier diagnostic category system with associated risks of malignancy (ROMs) and management recommendations. Submandibular Gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a higher relative proportion of malignancy, and this may affect the ROM and subsequent management. This study evaluated the application of the MSRSGC and the ROM for each diagnostic category for 734 submandibular Gland FNAs. Methods Submandibular Gland FNA cytology specimens from 15 international institutions (2013-2017) were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign Neoplasm, Salivary Gland Neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. A correlation with the available histopathologic follow-up was performed, and the ROM was calculated for each MSRSGC diagnostic category. Results The case cohort of 734 aspirates was reclassified according to the MSRSGC as follows: nondiagnostic, 21.4% (0%-50%); nonneoplastic, 24.2% (9.1%-53.6%); AUS, 6.7% (0%-14.3%); benign Neoplasm, 18.3% (0%-52.5%); SUMP, 12% (0%-37.7%); SM, 3.5% (0%-12.5%); and malignant, 13.9% (2%-31.3%). The histopathologic follow-up was available for 333 cases (45.4%). The ROMs were as follows: nondiagnostic, 10.6%; nonneoplastic, 7.5%; AUS, 27.6%; benign Neoplasm, 3.2%; SUMP, 41.9%; SM, 82.3%; and malignant, 93.6%. Conclusions This multi-institutional study shows that the ROM of each MSRSGC category for submandibular Gland FNA is similar to that reported for parotid Gland FNA, although the reported rates for the different MSRSGC categories were variable across institutions. Thus, the MSRSGC can be reliably applied to submandibular Gland FNA.
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the role of the milan system for reporting Salivary Gland cytopathology a 5 year institutional experience
2018Co-Authors: Kartik Viswanathan, Simon Sung, Theresa Scognamiglio, Grace C H Yang, Momin T Siddiqui, Rema RaoAbstract:Background Fine-needle aspiration (FNA) is widely accepted in the preoperative management of Salivary Gland lesions. The proposed Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) aims to standardize reporting terminology. Studies regarding the risk of malignancy (ROM) for the proposed categories continue to evolve. The current retrospective study applied the MSRSGC to assess ROM for Salivary Gland lesions and focused on the "indeterminate" categories. Methods A total of 627 Salivary Gland FNA specimens obtained from 2011 through 2016 were retrieved, with follow-up available for 373 cases. The original diagnoses were recategorized using MSRSGC by 2 independent cytopathologists as: 1) non-diagnostic; 2) non-neoplastic; 3) atypia of undetermined significance (AUS); 4a) benign Neoplasms; 4b) Salivary Gland Neoplasm of uncertain malignant potential (SUMP); 5) suspicious for malignancy (SFM); and 6) malignant. The ROM and overall ROM for each diagnostic category were determined, with characterization of "indeterminate" (AUS, SUMP, and SFM) lesions. Results There was near-perfect agreement regarding categorization (626 of 627 cases; 99.8%) between the 2 cytopathologists, with discordance observed for 1 case. The sensitivity, specificity, negative predictive value, and positive predictive value of Salivary Gland FNA specimens at the study institution were 79%, 98%, 94%, and 92%, respectively. The ROM for non-diagnostic, non-neoplastic, benign Neoplasms, AUS, SUMP, SFM, and malignant were 6.7%, 7.1%, 38.9%, 5.0%, 34.2%, 92.9%, and 92.3%, respectively. The indeterminate category had an overall ROM of 47.1%. Conclusions The MSRSGC is a valuable tool that can help to standardize reporting and stratify cases preoperatively. Having a better understanding of the indeterminate diagnoses will help further refine risk classification criteria. Cancer Cytopathol 2018. © 2018 American Cancer Society.
Iran Seif - One of the best experts on this subject based on the ideXlab platform.
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papillary cystic acinic cell carcinoma with many psammoma bodies so called psammoma body rich papillary cystic acinic cell carcinoma report of a case with fine needle aspiration findings
2009Co-Authors: Shahrzad Negahban, Yahya Daneshbod, Bijan Khademi, Iran SeifAbstract:Background Psammoma bodies are infrequent in Salivary Gland aspirates. We present a case of papillary cystic acinic cell carcinoma with many psammoma bodies and discuss the diagnostic pitfalls with other Salivary Gland tumors. Case A 24-year-old woman presented with a 5-month history of a gradually enlarging, painless lump in the left side of the face. Physical examination demonstrated a 2 x 2-cm, nontender, rubbery mass inferior to the auricle in the left parotid area. Sonography showed a 2-cm, cystic mass in the left parotid. Fine needle aspiration was performed and showed mainly papillary clusters and isolated cells with vacuolated cytoplasm and a round nucleus with an inconspicuous nucleolus resembling foamy histiocytes and many psammoma bodies, some of which were surrounded by cells resembling cannonballs. A preliminary diagnosis of papillary cystic Salivary Gland Neoplasm was made and superficial parotidectomy performed. A diagnosis ofpapillary cystic acinic cell carcinoma with many psammoma bodies was made. Conclusion Aspiration cytology of papillary cystic acinic cell carcinoma with many psammoma bodies can be confused with more common tumors, such as cystic mixed tumor and adenoid cystic carcinoma with cannonballs, low grade mucoepidermoid carcinoma or cystic papillary carcinoma of the thyroid.
Jenfan Hang - One of the best experts on this subject based on the ideXlab platform.
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application of the milan system for reporting Salivary Gland cytopathology a retrospective 12 year bi institutional study
2019Co-Authors: Fatimah Alruwaii, Jenfan Hang, Baorung Zeng, Harvey M Cramer, Chiung Ru LaiAbstract:Objectives Multi-institutional studies are required for the validation of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC). Methods A total of 1,560 fine-needle aspirations of the Salivary Glands were retrieved from two institutions for a 12-year period. The diagnoses were reclassified based on the MSRSGC. Risk of malignancy (ROM) for each category was calculated based on 694 histologic follow-up cases. Results The ROM for each category was: 18.3% for nondiagnostic, 8.9% for nonneoplastic, 37.5% for atypia of undetermined significance (AUS), 2.9% for benign Neoplasm, 40.7% for Salivary Gland Neoplasm of uncertain malignant potential (SUMP), 100% for suspicious for malignancy, and 98.3% for malignant. The sensitivity, specificity, positive predictive rate, and negative predictive rates were 89%, 99%, 98%, and 96%, respectively. Conclusions The results of the current study are in keeping with the MSRSGC. The indeterminate categories of AUS and SUMP showed intermediate ROMs at 37.5% and 40.7%, respectively.
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subtyping Salivary Gland Neoplasm of uncertain malignant potential based on cell type demonstrates differential risk of malignancy
2018Co-Authors: Jenfan Hang, Fatimah Alruwaii, Baorung Zeng, Howard H WuAbstract:BACKGROUND: The newly unveiled Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has proposed Salivary Gland Neoplasm of uncertain malignant potential (SUMP) as an indeterminate category. The category is reserved for fine-needle aspiration (FNA) cases that are diagnostic of a Salivary Gland Neoplasm but cannot be further designated as a specific tumor type. The objective of the current study was to evaluate the clinical utility of subtyping SUMP cases based on different cell types. METHODS: A retrospective search of cytology databases at 2 institutions for Salivary Gland FNAs from 2006 through 2017 was conducted. The cytologic diagnosis of each case was reclassified according to the MSRSGC. Histologic follow-up was retrieved for correlation. Cases reclassified as SUMP that had a follow-up pathologic diagnosis were subject to cytology review and subtyping into oncocytic/squamoid, basaloid, or myoepithelial subtypes based on cytomorphology. The risk of malignancy (ROM) for each subtype was analyzed. RESULTS: There were 92 SUMP cases, which comprised 5.9% of 1560 consecutive Salivary Gland FNAs within the 12-year study period. Histologic follow-up was available for 59 patients. After cytology review, there were 18 cases (30.5%) of oncocytic/squamoid subtype, 25 (42.4%) of basaloid subtype, and 16 (27.1%) of myoepithelial subtype. Pathologic correlation revealed an ROM of 61.1% (11 of 18 cases) for the oncocytic/squamoid subtype, 40.0% (10 of 25 cases) for the basaloid subtype, and 18.8% (3 of 16 cases) for the myoepithelial subtype. The differences in ROM among the 3 subtypes were statistically significant (P = .0476). CONCLUSIONS: Subtyping SUMP cases into categories based on cell type demonstrated differential ROMs for better clinical stratification. Future prospective studies are mandatory to confirm this finding.
William C Faquin - One of the best experts on this subject based on the ideXlab platform.
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cytomorphology and diagnostic pitfalls of sebaceous and nonsebaceous Salivary Gland lymphadenoma a multi institutional study
2021Co-Authors: Kartik Viswanathan, Zahra Maleki, Liron Pantanowitz, Richard Cantley, William C FaquinAbstract:BACKGROUND Salivary Gland lymphadenoma (LAD) is a rare benign Neoplasm comprising sebaceous (SLAD) and nonsebaceous (NSLAD) types. Despite established histologic criteria, limited data on cytomorphology, tumor heterogeneity, and overlap with other entities make the diagnosis of LAD by fine needle aspiration (FNA) challenging. We describe a multi-institutional cohort of 14 LADs with cytology, clinical, radiologic, and histopathologic data. METHODS Our cohort included nine SLAD and five NSLAD with corresponding histopathology. Mean patient age and M:F ratio were 60.4 years (range 45-86 years) and 1:2 for SLADs and 57.4 years (range 42-80 years) and 1:1.5 for NSLADs, respectively. One NSLAD patient had a germline predisposition for Cowden syndrome. Glass slides and whole slide images of air-dried Diff-Quik (DQ), alcohol-stained Papanicolaou smears (Pap) and cellblocks were reviewed for key cytomorphologic findings. RESULTS FNAs from SLAD and NSLADs demonstrated vacuolated and basaloid epithelial clusters within a lymphoid background. Vacuolated cells from SLAD showed sebaceous cells with microvesicular cytoplasm indenting a central nucleus. Vacuolated cells from NSLAD were columnar with eccentric nuclei, corresponding to abluminal Glandular cells. SLADs were classified using the Milan System for Reporting Salivary Gland Cytopathology as nondiagnostic (11.1%), nonneoplastic (44.4%), atypia of uncertain significance (AUS) (22.2%), and Salivary Gland Neoplasm of uncertain malignant potential (SUMP) (22.2%). NSLADs were classified as AUS (40%), SUMP (40%) and Benign Neoplasm (20%). CONCLUSION Although rare, knowing the cytologic features of Salivary LAD is important to avoid diagnostic pitfalls. Vacuolated cells can be prominent in both SLAD and NSLAD aspirates. Diagnostic issues arise from insufficient sampling of all tumor components leading to marked variation in diagnostic classification of LAD.
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a call for universal acceptance of the milan system for reporting Salivary Gland cytopathology
2020Co-Authors: Eric Barbarite, Sidharth V Puram, Adeeb Derakhshan, Esther Diana Rossi, William C Faquin, Mark A VarvaresAbstract:Objectives The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) established a standardized, tiered reporting system for Salivary Gland fine-needle aspiration (FNA) that has gained international acceptance among cytologists. Our goal was to review the key features of the MSRSGC to familiarize the surgical community with this system and its application to the FNA evaluation of Salivary Gland masses. Methods A comprehensive review of the MSRSGC and its application in clinical practice. Results The MSRSGC consists of six major diagnostic categories: 1) nondiagnostic, 2) non-neoplastic, 3) atypia of undetermined significance, 4) Neoplasm (benign or Salivary Gland Neoplasm of uncertain malignant potential), 5) suspicious for malignancy, and 6) malignant. Each diagnostic category is associated with an implied risk of malignancy with implications for clinical management. Conclusions The MSRSGC is similar to the system used for reporting thyroid FNA, which is familiar to most otolaryngologists and head and neck surgeons. As this reporting system continues to gain popularity among pathologists, widespread understanding by surgeons will be important to standardize communication and classification of Salivary Gland cytopathology to improve clinical care. Laryngoscope, 130:80-85, 2020.
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the milan system for reporting Salivary Gland cytopathology msrsgc an international effort toward improved patient care when the roots might be inspired by leonardo da vinci
2018Co-Authors: Esther Diana Rossi, William C FaquinAbstract:The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) represents a standardized, evidence-based reporting system for Salivary Gland fine-needle aspiration (FNA). The role of FNA is well established for the preoperative evaluation of patients with Salivary Gland lesions; however, the lack of a uniform system for Salivary Gland FNA has limited its effectiveness. To address this, an international panel of experienced cytopathologists proposed a uniform reporting system in 2015 under the sponsorship of the American Society of Cytopathology and the International Academy of Cytology. The MSRSGC consists of 6 diagnostic tiers: 1) nondiagnostic, 2) non-neoplastic, 3) atypia of undetermined significance, 4) Neoplasm (subdivided into benign and Salivary Gland Neoplasm of uncertain malignant potential), 5) suspicious for malignancy, and 6) malignant. On the basis of evidence from the literature, each category has a suggested risk of malignancy that ranges from 5% for the Neoplasm-benign category to >90% for the malignant category. The overall goal of the MSRSGC is to improve the effectiveness of Salivary FNA by providing a uniform system with the ultimate result of better communication and improved patient care.
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fine needle aspiration biopsy of a cystic pleomorphic adenoma with extensive adnexa like differentiation differential diagnostic pitfall with mucoepidermoid carcinoma
2003Co-Authors: F Elena M D Brachtel, Z Ben M D Pilch, M Urmila D Khettry, Artur Zembowicz, William C FaquinAbstract:Although fine-needle aspiration biopsy (FNAB) is a highly accurate tool for the diagnosis of pleomorphic adenomas, even this common Salivary Gland Neoplasm can be diagnostically challenging and cause pitfalls in cytodiagnosis. In particular, the presence of either cystic degeneration or squamous and mucinous metaplasia can lead to a false positive diagnosis of malignancy. Here we present the case of a 16-year-old female who presented with a painless, slowly growing mass in the superficial lobe of the right parotid Gland. Magnetic resonance imaging of the parotid demonstrated a mass with heterogeneous postcontrast enhancement and a central, nonenhancing area suggestive of necrosis. FNAB of the lesion yielded proteinaceous debris and numerous whorls of keratin, small cohesive clusters of basaloid and squamoid epithelial cells, and many vacuolated and foamy cells. Initially and after consultation at an outside institution, the FNAB was reported as an “atypical Neoplasm, cannot exclude mucoepidermoid carcinoma.” A total, nerve-sparing parotidectomy and level II neck dissection revealed a pleomorphic adenoma with central cystic degeneration and extensive mixed appendageal differentiation. While foci of squamous metaplastic changes may occur in pleomorphic adenomas, the combination of cystic degeneration and extensive appendageal differentiation with numerous keratotic cysts is rare, and it presents the potential for misinterpretation of the FNAB as indicative of malignancy in general, and mucoepidermoid carcinoma in particular. Diagn. Cytopathol. 2003;28:100–103. © 2003 Wiley-Liss, Inc.
