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Case 15

View the images and select the correct diagnosis from the list below.

A mucoid mystery

FNAB of a 1.5 cm firm, painless parotid lesion, present for 10 years in a 45-year-old man:











Select the correct diagnosis:

You answered: Salivary duct cyst
Sorry, that is INCORRECT


The correct diagnosis is: Low-grade mucoepidermoid carcinoma

CYTOPATHOLOGY:

  • The specimen consists of clusters of intermediate cells mixed with mildly atypical mucous-producing cells in a background containing abundant mucous 
  • Consistent with low-grade mucoepidermoid carcinoma

DISCUSSION:

  • The biopsy reveals numerous mucous-secreting cells with focal sheets of intermediate cells
  • Marked cystic change and a dense collagenous stroma were also identified in areas of the tumour
  • Low-grade MEC is one of the most common salivary gland malignancies occurring in all age groups
  • It is usually well-demarcated, slow-growing and painless
  • Coexistence of intermediate cells showing epidermoid differentiation and mucin-secreting cells is required for definitive diagnosis in cytologic preparations
  • Abundant mucous may suggest salivary duct cyst but the presence of mucous/goblet cells favours mucoepidermoid carcinoma that may rarely be rich in oncocytes
  • Pleomorphic adenoma may have mucous and squamous metaplasia but it is usually focal.  Chondromyxoid stroma best identified on Giemsa stain and free lying myoepithelial cells suggest pleomorphic adenoma
  • Low grade tumours have a predominance of uni- or multilocular cystic mucinous components versus high grade tumours that are mainly solid with intermediate and squamous cells, high grade nuclear features and minimal mucous differentiation.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Orell SR, Sterrett GF, Whitaker D.  Fine Needle Aspiration Cytology, 4th ed.  Elsevier Churchill Livingstone; 2005. pp67-69.
Elhosseiny A. Salivary Glands in Koss' Diagnostic Cytology and Its Histopathologic Bases, 5th ed.  Lippincott Williams & Wilkins; 2006pp 1243-1246.

You answered: Warthin's tumour with mucoid stroma 
Sorry, that is INCORRECT

The correct diagnosis is: Low-grade mucoepidermoid carcinoma

CYTOPATHOLOGY:

  • The specimen consists of clusters of intermediate cells mixed with mildly atypical mucous-producing cells in a background containing abundant mucous 
  • Consistent with low-grade mucoepidermoid carcinoma

DISCUSSION:

  • The biopsy reveals numerous mucous-secreting cells with focal sheets of intermediate cells
  • Marked cystic change and a dense collagenous stroma were also identified in areas of the tumour
  • Low-grade MEC is one of the most common salivary gland malignancies occurring in all age groups
  • It is usually well-demarcated, slow-growing and painless
  • Coexistence of intermediate cells showing epidermoid differentiation and mucin-secreting cells is required for definitive diagnosis in cytologic preparations
  • Abundant mucous may suggest salivary duct cyst but the presence of mucous/goblet cells favours mucoepidermoid carcinoma that may rarely be rich in oncocytes
  • Pleomorphic adenoma may have mucous and squamous metaplasia but it is usually focal.  Chondromyxoid stroma best identified on Giemsa stain and free lying myoepithelial cells suggest pleomorphic adenoma
  • Low grade tumours have a predominance of uni- or multilocular cystic mucinous components versus high grade tumours that are mainly solid with intermediate and squamous cells, high grade nuclear features and minimal mucous differentiation.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Orell SR, Sterrett GF, Whitaker D.  Fine Needle Aspiration Cytology, 4th ed.  Elsevier Churchill Livingstone; 2005. pp67-69.
Elhosseiny A. Salivary Glands in Koss' Diagnostic Cytology and Its Histopathologic Bases, 5th ed.  Lippincott Williams & Wilkins; 2006pp 1243-1246.

You answered: Low-grade mucoepidermoid carcinoma

CORRECT!!

CYTOPATHOLOGY:

  • The specimen consists of clusters of intermediate cells mixed with mildly atypical mucous-producing cells in a background containing abundant mucous 
  • Consistent with low-grade mucoepidermoid carcinoma

DISCUSSION:

  • The biopsy reveals numerous mucous-secreting cells with focal sheets of intermediate cells
  • Marked cystic change and a dense collagenous stroma were also identified in areas of the tumour
  • Low-grade MEC is one of the most common salivary gland malignancies occurring in all age groups
  • It is usually well-demarcated, slow-growing and painless
  • Coexistence of intermediate cells showing epidermoid differentiation and mucin-secreting cells is required for definitive diagnosis in cytologic preparations
  • Abundant mucous may suggest salivary duct cyst but the presence of mucous/goblet cells favours mucoepidermoid carcinoma that may rarely be rich in oncocytes
  • Pleomorphic adenoma may have mucous and squamous metaplasia but it is usually focal.  Chondromyxoid stroma best identified on Giemsa stain and free lying myoepithelial cells suggest pleomorphic adenoma
  • Low grade tumours have a predominance of uni- or multilocular cystic mucinous components versus high grade tumours that are mainly solid with intermediate and squamous cells, high grade nuclear features and minimal mucous differentiation.

BACK TO IMAGES


HISTOLOGY


REFERENCES:

Orell SR, Sterrett GF, Whitaker D.  Fine Needle Aspiration Cytology, 4th ed.  Elsevier Churchill Livingstone; 2005. pp67-69.

Elhosseiny A. Salivary Glands in Koss' Diagnostic Cytology and Its Histopathologic Bases, 5th ed.  Lippincott Williams & Wilkins; 2006pp 1243-1246.

You answered: Pleomorphic adenoma with mucoid stroma 
Sorry, that is INCORRECT


The correct diagnosis is: Low-grade mucoepidermoid carcinoma

CYTOPATHOLOGY:

  • The specimen consists of clusters of intermediate cells mixed with mildly atypical mucous-producing cells in a background containing abundant mucous 
  • Consistent with low-grade mucoepidermoid carcinoma

DISCUSSION:

  • The biopsy reveals numerous mucous-secreting cells with focal sheets of intermediate cells
  • Marked cystic change and a dense collagenous stroma were also identified in areas of the tumour
  • Low-grade MEC is one of the most common salivary gland malignancies occurring in all age groups
  • It is usually well-demarcated, slow-growing and painless
  • Coexistence of intermediate cells showing epidermoid differentiation and mucin-secreting cells is required for definitive diagnosis in cytologic preparations
  • Abundant mucous may suggest salivary duct cyst but the presence of mucous/goblet cells favours mucoepidermoid carcinoma that may rarely be rich in oncocytes
  • Pleomorphic adenoma may have mucous and squamous metaplasia but it is usually focal.  Chondromyxoid stroma best identified on Giemsa stain and free lying myoepithelial cells suggest pleomorphic adenoma
  • Low grade tumours have a predominance of uni- or multilocular cystic mucinous components versus high grade tumours that are mainly solid with intermediate and squamous cells, high grade nuclear features and minimal mucous differentiation.

BACK TO IMAGES


 HISTOLOGY


REFERENCES:

Orell SR, Sterrett GF, Whitaker D.  Fine Needle Aspiration Cytology, 4th ed.  Elsevier Churchill Livingstone; 2005. pp67-69.
Elhosseiny A. Salivary Glands in Koss' Diagnostic Cytology and Its Histopathologic Bases, 5th ed.  Lippincott Williams & Wilkins; 2006pp 1243-1246.

Case 15 Histology - Low-grade mucoepidermoid carcinoma

 

   

From the Cytopathology files of BC Cancer
Submitted by: Brenda Smith, BSc and Tom Thomson, MD

SOURCE: Case 15 ( )
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