Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland
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INVITED REVIEW
Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland Liron Pantanowitz1,4 · Lester D. R. Thompson2 · Esther Diana Rossi3 Received: 3 February 2018 / Accepted: 28 February 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract 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. Keywords Fine-needle · Cyst fluid · Cysts · Cytology · Salivary glands · Milan system
Introduction Several non-neoplastic lesions, benign neoplasms, and malignancies of the salivary gland can present with a predominant or minor cystic component [1, 2]. It is important to distinguish these lesions from one another because patient management often differs among these groups. At least one-third of cystic salivary gland lesions are neoplastic [3]. Table 1 lists common cystic salivary gland lesions likely to be encountered. Non-neoplastic cystic salivary gland lesions can be divided into true cysts (e.g., lymphoepithelial cyst) * Liron Pantanowitz [email protected] 1
Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, USA
2
Pathology Department, Woodland Hills Medical Center, Woodland Hills, CA, USA
3
Division of Anatomic Pathology and Histology, Agostino Gemelli School of Medicine, Catholic University of Sacred Heart, Rome, Italy
4
Department of Pathology, UPMC Shadyside UPMC Cancer Pavilion, Suite 20, 5150 Centre Ave, Pittsburgh, PA 15232, USA
and non-developmental cysts (e.g., retention cyst) [4]. Occasionally, one may also encounter more rare cystic lesions in the salivary gland such as an epidermoid cyst [5], keratocystoma [6], odontogenic keratocyst [7], and primary hydatid cyst in endemic regions [8]. Salivary gland cysts can typically be identified by ultrasound. However, occasionally, benign or malignant tumors (e.g., lymphoma, metastases) can be misinterpreted as a simple cyst, pseudocysts can be hard to discern, and paradoxically certain cystic lesions can prese
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