Fine Needle Aspiration of Chronic Sclerosing Sialadenitis (Kuttner's Tumour): A Potential Pitfall. A Series of 4 Cases
ME Leon, A Agrawal, E Ozer, T Teknos, OH Iwenofu. The Ohio State Univ, Columbus, OH; The Ohio State Univ., Columbus, OH
Background: Chronic sclerosing sialadenitis (CSS) is a benign and chronic inflammatory condition of the salivary gland. Clinically, CSS patients may present with a neck nodule or mass often suggesting a neoplastic process. Fine needle aspiration (FNA) is frequently used to evaluate these lesions. We present a series of 4 cases of CSS. The cytologic as well as the tissue biopsy findings of these cases are reviewed.
Design: 4 cases, two females and two males, that underwent resections of neck nodules with a surgical pathology diagnosis of CSS were identified. The histopathology was reviewed by two pathologists. The clinical and pathologic findings were reviewed.
Results: The mean age was 66.2 years. All patients presented with a palpable lesion in the head and neck, 3 with submandibular nodules and one with a parotid nodule, measuring 1.5 cm in average size. Three patients had a history of a squamous cell carcinoma (SCCA) of the head and neck. A patient had a history of malignant melanoma of the neck skin. All 4 cases had a FNA prior to surgery. The immediate diagnosis (IDx) given in 3 cases was carcinoma, SCCA, and salivary gland neoplasm respectively. The final diagnosis (FDx) in these cases was SCCA, basaloid neoplasm, and salivary gland neoplasm respectively. In a case, only a FDx of SCCA was given. Cytologically, all the cases showed rare cell clusters with squamoid appearance and tridimensional architecture and minimal to mild nuclear atypia. A cellular aspirate was not seen in these cytologic preparations. All the patients had intraoperative consultation (IOC). Grossly, 3 cases showed no evidence of tumor; and in one case, a 1.1 cm white tan nodule was identified. In the IOC, the lesions were identified as benign (n=2), atrophic salivary gland with chronic inflammation(n=1), and as sialadenitis with atypical glands (n=1). All the resected specimens show benign salivary glands with prominent fibrosis, encasing the lobules, focal squamous metaplasia, mild to moderate lymphoplasmacytic infiltrates, features which mirror the FNA findings. The diagnosis in these surgical specimens were consistent with CSS.
Conclusions: CSS is a potential pitfall in the FNA interpretation of salivary gland lesions. Awareness of this entity, adherence to strict cytologic criteria, and careful clinicopathologic correlation are helpful in preventing a misinterpretation.
Wednesday, March 24, 2010 1:00 PM
Poster Session VI # 52, Wednesday Afternoon