38 year male patient superficial parotidectomy ..grossly homogenous grey white infiltrating tumor..FNA diagnosis - PLGA ..Histopath slides are here..opinion please??

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Shows tumour surrounded by thick capsule and divided into lobules of varying sizes. At the periphery of lobules & interspersed inbetween are seen few epithelial cells. Lobules are composed of vacuolated cells of variable sizes having compressed small bland nucleus at the periphery, interspersed by pink material. Some of the cells are appearing like lipoblasts. Large hyperchromatic vesicular nuclei of epithelial cells is lacking. No mucin production appreciated. ? Signet ring type of cells noted. No intermediate cells/ tall columnar mucin secreting cells / squamous cells or basaloid cells noted. No necrosis or No mitosis noted. No zymogen granules noted. Impression : P/O : * Lipomatous Pleomorphic Adenoma. * Well diffentiated Liposarcoma. * ? Low grade Mucoepudermoid carcinoma. * ? Clear cell predominant Myoepithelioma. Advised Mucin stains & IHC with S100, CK7, P63.

Malignant Salivary gland tumour D/D 1.Colloid carcinoma (Mucin rich variant) 2.Mucoepidermoid carcinoma 3.Adenoid cystic carcinoma However,IHC/Molecular/Cytogenetics study to be carried out for needful.

Why not clear cell carcinoma or epithelial- myoepithelial carcinoma??
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Nice. Why a superficial parotidectomy for an infiltrating tumour. ?Facial nerve status . Glandular pattern is preserved . Recurrence is very common after superficial resection in pleomorphic adenoma.

No focal areas of mucoepidermoid carcinoma, adenoid cystic, acinic cell carcinoma in any slides..hence considering the differentials of epithelial- myoepithelial carcinoma and clear cell carcinoma..

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Looks like low grade mucoepidermoid carcinoma. More pics required..

D/d Adenoid Cystic carcinoma Mucinous adenocarcinoma

Consistent with.. Mucinous adenocarcinoma

Malignant... Probably mucoepidermoid

Lipomatous pleomorphic adenoma

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