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This is a low power view of lesional tissue showing cystic spaces lined by squamous type epithelium with lymphoid tissue including a germinal centre on the right. These cysts show a mixture of squamous and ductal type epithelial lining with prominent infiltration by small lymphocytes. The Inset (top right corner) is low power view of a H&E stained slide showing ductal structures surrounded by blood vessels with abundant lymphoid tissue in the adjacent stroma. Scattered small islands of epithelium are identified in the lymphoid stroma. These represent branchial pouch-derived inclusions which proliferate to form cysts under the influence of growth factors produced by the hyperplastic lymphoid tissue. In line with the lymph node inclusion theory, some of these consist of pink staining oncocytic epithelium of the type as seen in Warthin’s tumours.F
Source publication
Cystic lesions within the parotid gland are uncommon and clinically they are frequently misdiagnosed as tumours. Many theories have been proposed as to their embryological origin. A 20-year retrospective review was undertaken of all pathological codes (SNOMED) of all of patients presenting with any parotid lesions requiring surgery. After analysis...
Citations
... 22 The majority of congenital parotid gland cysts involve the superficial lobe of the parotid gland, which is sometimes referred to as a branchial cleft cyst. 23,24 In patients with a history of salivary duct obstruction, acquired parotid duct cysts are often suspected. 25 Parotid duct cysts are usually lined with stratified squamous epithelium and subepithelial lymphoid tissue. ...
Mucoepidermoid carcinoma (MEC) is a common malignancy arising in the parotid gland. The diagnosis of MEC is typically based on its morphological features alone, characteristically containing mucocytes, intermediate cells and epidermoid cells. However, when cystic degeneration is diffuse, it is challenging to distinguish MEC from other benign cystic tumors. This is a case report of a 58-year-old Caucasian man who presented with a parotid mass. H&E sections of the mass reveal multiloculated cysts lined by bland-looking epithelium with only rare papillary architectures. The papillary proliferation contains mucocytes, and epidermoid cells highlighted by the p63 immunohistochemistry study. The diagnosis was confirmed by FISH result of positive MAML2 (11q21) rearrangement. Patient underwent parotidectomy and is disease-free 6 months post-surgery. MEC with cystic degeneration is a common diagnostic pitfall which can mimic many benign lesions in the salivary gland. We present a rare case with MEC with extensive cystic change, its molecular and pathologic findings and review the diagnostic features of MEC, its benign mimickers and useful tools for distinguishing these entities.
... Similar US findings with a peripheral hyperechoic component and vertically oriented vessels have been previously reported in JX lesions located subcutaneously and in the dermis [10] . JX should be differentiated from a brachial cleft cyst, which is very rarely encountered in the major salivary glands and is mainly seen in HIV positive children [11] nonepithelial masses such as infantile hemangioma and hemangioendotheliomas which show higher vascularity and have phlebolith-like calcifications [12] ; a basal cell adenoma of the parotid gland which is an extremely rare complex cystic mass that occurs exclusively in fifth to seventh decade of life [13] ; a congenital Warthin tumor which is very rare mass, associated with bone destruction and calcification [14] . ...
Juvenile xanthogranuloma (JX) is a non-Langerhans cell histiocytosis. Although precipitating factors remain unclear, it has been described mainly in infancy and early childhood. The giant variant of JX is a rare form that presents in infancy, measures over 2 cm and tends to involute only partly. Herein, we report a very rare localization of a giant JX in the parotid gland, discovered at age 1 month in an infant of a twin pregnancy and studied with ultrasound and magnetic resonance imaging.
... Occasionally, branchial cleft cysts and lymphoepithelial cysts in human immunodeficiency virus-positive patients may be mistaken for cystic salivary gland lesions. 20,21 Lymphocytes can be seen in a wide variety of cystic salivary gland lesions. Lymphocytes are an essential element in rendering a diagnosis of benign conditions such as Warthin tumor and intraparotid lymph nodes. ...
Background
Cystic salivary gland lesions present diagnostic challenges on fine‐needle aspiration (FNA) specimens that are related to sampling limitations and a broad differential diagnosis. This study evaluated the benefit of applying the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) to a series of cystic salivary gland lesions.
Methods
The pathology archives at the Johns Hopkins Hospital were searched to identify cystic salivary gland FNA specimens over a 19‐year period (2000‐2018). Patient demographics, cytomorphologic features, and clinical and surgical follow‐up were recorded. The MSRSGC was applied to the cases. The risk of malignancy (ROM) and the risk of neoplasia (RON) were calculated for each category.
Results
One hundred seventy‐eight cases were identified (96 males and 82 females) with a mean age of 53 years (range, 4‐90 years). After the MSRSGC was applied, there were 52 nondiagnostic cases (29.2%), 80 nonneoplastic cases (44.9%), 35 cases of atypia of undetermined significance (AUS; 19.7%), 3 benign neoplasms (1.7%), 3 salivary gland neoplasms of uncertain malignant potential (SUMP; 1.7%), 4 cases suspicious for malignancy (SFM; 2.2%), and 1 malignant case (0.6%). One hundred fifty‐six of the 178 patients (87.6%) had follow‐up data available. The RON and ROM values for cases with surgical follow‐up were 33.3% (3 of 9) and 22.2% (2 of 9) for the nondiagnostic category, 42.9% (9 of 21) and 19% (4 of 21) for the nonneoplastic category, 76.5% (13 of 17) and 29.4% (5 of 17) for the AUS category, 100.0% (2 of 2) and 50.0% (1 of 2) for the SUMP category, and 100% (2 of 2) and 100% (2 of 2) for the SFM category, respectively.
Conclusions
Applying the MSRSGC to cystic salivary gland lesions improves patient management by preventing unnecessary surgery for nonneoplastic conditions. The ROM was highest in the SFM category (100%), which was followed by the SUMP, AUS, nondiagnostic, and nonneoplastic categories. Less than adequate specimens may increase the diagnosis of AUS.
... The term lymphoepithelial cyst (LEC) was introduced in 1958, instead of branchial cleft cyst [38]. LEC may be single (simple) (Fig. 6), but more recently, have been associated with HIV/AIDS [39][40][41]. HIV-associated LEC usually manifest as multiple, bilateral lesions affecting the parotid glands. They may sometimes be the first manifestation of HIV infection. ...
Fine needle aspiration (FNA) has diagnostic and therapeutic value in the management of salivary gland cysts. Rendering an accurate diagnosis from an aspirated salivary gland cyst is challenging because of the broad differential diagnosis, possibility of sampling error, frequent hypocellularity of specimens, morphologic heterogeneity, and overlapping cytomorphology of many cystic entities. To date, there have been no comprehensive review articles providing a practical diagnostic approach to FNA of cystic lesions of salivary glands. This article reviews the cytopathology of salivary gland cysts employing 2017 World Health Organization terminology, addresses the accuracy of FNA, and presents The Milan System approach for reporting in cystic salivary gland cases. The utility of separating FNA specimens from salivary gland cysts, based upon the presence of mucin and admixed lymphocytes in cyst fluid is demonstrated. A reliable approach to interpreting FNA specimens from patients with cystic salivary gland lesions is essential to accurately determine which of these patients may require subsequent surgery.
... Verschillende theorieën worden voorgesteld omtrent de histogenese van branchiale cysten, maar tot op heden blijft hun oorsprong controversieel (Upile et al., 2012). De meest populaire verklaringen bij de mens impliceren ontwikkelingsstoornissen van het branchiale systeem of epitheliale inclusies in cervicale lymfeknopen (Rickles en Little, 1967;Glosser et al., 2003;Upile et al., 2012). ...
... Verschillende theorieën worden voorgesteld omtrent de histogenese van branchiale cysten, maar tot op heden blijft hun oorsprong controversieel (Upile et al., 2012). De meest populaire verklaringen bij de mens impliceren ontwikkelingsstoornissen van het branchiale systeem of epitheliale inclusies in cervicale lymfeknopen (Rickles en Little, 1967;Glosser et al., 2003;Upile et al., 2012). Aanhangers van deze laatste theorie hanteren de term 'cervicale lymfo-epitheliale cyste' (Glosser et at., 2003;Upile et al., 2012). ...
... De meest populaire verklaringen bij de mens impliceren ontwikkelingsstoornissen van het branchiale systeem of epitheliale inclusies in cervicale lymfeknopen (Rickles en Little, 1967;Glosser et al., 2003;Upile et al., 2012). Aanhangers van deze laatste theorie hanteren de term 'cervicale lymfo-epitheliale cyste' (Glosser et at., 2003;Upile et al., 2012). Aangezien het branchiale systeem algemeen het meest wordt aanvaard als bron van de branchiale cysten bij mens en dier (Karbe, 1965;Liu et al., 1983;Clark et al., 1989;Golledge en Ellis, 1994), wordt in dit artikel verder ingegaan op de branchiale origine. ...
A 6-year-old spayed Cavalier King Charles was presented with a reoffending subcutaneous swelling in the region of the left jaw. Based on the clinical and ultrasonographic findings, a sialocele of the left parotid salivary gland was suspected. Surgical excision of the left parotid salivary gland was recommended. During surgical exploration, cystic processes in the left parotid salivary gland as well as a more ventrally localized cyst were observed. The parotid and the adjacent cyst were excised. Based on the histopathological findings, a branchial cyst was diagnosed. Apart from a temporary mild paralysis of the facial nerve, the dog recovered well. To date, more than a year later, no recurrence has been observed.
... Verschillende theorieën worden voorgesteld omtrent de histogenese van branchiale cysten, maar tot op heden blijft hun oorsprong controversieel (Upile et al., 2012). De meest populaire verklaringen bij de mens impliceren ontwikkelingsstoornissen van het branchiale systeem of epitheliale inclusies in cervicale lymfeknopen (Rickles en Little, 1967;Glosser et al., 2003;Upile et al., 2012). ...
... Verschillende theorieën worden voorgesteld omtrent de histogenese van branchiale cysten, maar tot op heden blijft hun oorsprong controversieel (Upile et al., 2012). De meest populaire verklaringen bij de mens impliceren ontwikkelingsstoornissen van het branchiale systeem of epitheliale inclusies in cervicale lymfeknopen (Rickles en Little, 1967;Glosser et al., 2003;Upile et al., 2012). Aanhangers van deze laatste theorie hanteren de term 'cervicale lymfo-epitheliale cyste' (Glosser et at., 2003;Upile et al., 2012). ...
... De meest populaire verklaringen bij de mens impliceren ontwikkelingsstoornissen van het branchiale systeem of epitheliale inclusies in cervicale lymfeknopen (Rickles en Little, 1967;Glosser et al., 2003;Upile et al., 2012). Aanhangers van deze laatste theorie hanteren de term 'cervicale lymfo-epitheliale cyste' (Glosser et at., 2003;Upile et al., 2012). Aangezien het branchiale systeem algemeen het meest wordt aanvaard als bron van de branchiale cysten bij mens en dier (Karbe, 1965;Liu et al., 1983;Clark et al., 1989;Golledge en Ellis, 1994), wordt in dit artikel verder ingegaan op de branchiale origine. ...
A 6-year-old spayed Cavalier King Charles was presented with a reoffending subcutaneous swelling in the region of the left jaw. Based on the clinical and ultrasonographic findings, a sialocele of the left parotid salivary gland was suspected. Surgical excision of the left parotid salivary gland was recommended. During surgical exploration, cystic processes in the left parotid salivary gland as well as a more ventrally localized cyst were observed. The parotid and the adjacent cyst were excised. Based on the histopathological findings, a branchial cyst was diagnosed. Apart from a temporary mild paralysis of the facial nerve, the dog recovered well. To date, more than a year later, no recurrence has been observed.
Cystic lesions of the salivary glands are very uncommon entities. However, on occasion, some neoplasms of the salivary glands show a cystic component, which may be predominant or only partially cystic. Basal cell adenoma, canalicular adenoma, oncocytoma, sebaceous adenoma, intraductal papilloma, epithelial-myoepithelial carcinoma, intraductal carcinoma, and secretory carcinoma are such cystic entities. Cystic degeneration and necrosis, which can develop within solid tumours, represent another possibility. The ability to recognise this type of lesion is a challenge in diagnostic cytology because hypocellular fluid is frequently recovered. Furthermore, evaluating all of the differential diagnoses for cystic lesions of the salivary glands is helpful in obtaining the correct diagnosis. Herein, we evaluate the various types of cystic lesions within the salivary glands.
Background
Pleomorphic adenoma with extensive squamous metaplasia is relatively uncommon. Most reported cases in the English literature have involved the minor salivary glands.
Case report
A 49-year-old male presented with a 5-year history of a right submandibular lump diagnosed as an adenoma on ultrasound. Excision was conducted under general anesthesia. Histological evaluation revealed a pleomorphic adenoma with extensive squamous metaplasia.
Discussion
Pleomorphic adenoma with extensive squamous metaplasia can present a diagnostic dilemma as the differential diagnoses include benign and malignant entities, this is particularly so for small biopsy specimens. We describe an unusual occurrence of this entity in a major salivary gland and discuss its differential diagnoses.
The ultrasound (US) can be used successfully for the evaluation of structures and pathological changes of facial soft tissues and muscles of the maxillofacial region. Ultrasonography (USG) is a nonionizing, noninvasive, inexpensive, and painless imaging tool that can be performed as much as needed in a very short time and in children and pregnant women. Additionally, US probe may be used to palpate a lesion to understand the stiffness or compressibility of it, a feature not present in magnetic resonance imaging and computed tomography. It is important to know the normal sonographic features of facial structures to be able to recognize the pathology. In this chapter, we discuss the role of ultrasonography (USG) in the examination of facial soft tissues and muscles of the maxillofacial region. We provide the USG characteristics of normal anatomy and series of the most often encountered pathologic conditions of the facial structures to facilitate image interpretation of USG scans for clinicians.
In the third edition of Diagnostic Surgical Pathology of the Head and Neck , Chapter 6 provides a most comprehensive description of Salivary gland pathology. The chapter contains details of embryology, anatomy, developmental, inflammatory, immunological and other non-neoplastic disorders which tend to be neglected in most surgical pathology books mainly focused on tumour pathology.
The malignant and benign neoplastic disorders presented in Chapter 6 are described in depth from the clinical/imaging/histological point of view up to most recent molecular pathology data providing an overview of the significant changes occurred in the salivary gland neoplasia over the last decades. There is an extensive collection of histological and immunohistochemical pictures as well as multiple tables summarising the essential features of salivary gland pathology.
For those reasons Chapter 6 represents an essential guide for both senior and young Head and Neck and Oral Pathologists, Otolaryngologists and Head and Neck Surgeons.
