Good evening Curofians. Case details : 52 year old female, Left parotid swelling [Clinical Image] since 8 months. On examination the swelling is soft to firm, slightly mobile, mildly tender. FNAC done. Aspirated blood. Attached 01 clinical picture and 09 micropictographs. Is it benign, suspicious for malignancy or a malignant lesion. Give relevant cytological description and your differential diagnosis. Thanks all. Best regards. [Credits : Dr. Kazi Wajid Husain]



Respected sir, thank you for posting this case and uploading images on request. This shows ur patience and kind gesture. Now coming to this tricky case. M/E : FNA smears from a preauricular swelling is moderately cellular and shows clusters and monolayered sheets of acinar cells, some of which exhibit oncocytic change with moderate anisonucleosis and abundant granular cytoplasm. Image 9 shows sheet of ductal epithelial cells, some of which show Squamous metaplasia (one can see at the lower end). Now fig 10 image shows ? necrotic debris with inflammatory cells ? entrapped inflammatory cells in fibrin ? stromal fragment (not sure as thr image gets blurred on zooming). However no typical chondromyxoid stromal fragment is noted. Impression : FNA from a preauricular swelling showing an oncocyte rich neoplasm. Advice excisional biopsy for confirmation and further Subtyping. Mostly it's benign but Sir, let's play safe since FNAC can often be misleading to call as benign or malignant. Now coming to the differentials : 1. Oncocytoma : possible but metaplastic ductal epithelial cells and? debris. 2. Oncocytic carcinoma : more atypia, miyosis, necrosis are evident 3. Warthins tumour : lymphocytes seen in background 4. Pleomorphic adenoma : no chondromyxoid background 5. Mucoepidermoid carcinoma :??? 6. Acinic cell carcinoma : well formed Acini are not seen. 7. Metastatic RCC So with quite a big list of oncocyte rich neoplasm, I guess will keep it safe and word the report as oncocyte rich neoplasm. In a salivary gland neoplasm the hallmark features of malignancy is invasion into surrounding parenchyma. Thank you once again sir. Regards...

nice approach

Revered sirs and madams, @Dr. Dhanalakshmi Dineshkumar @Dr. Sivaganesh Porko @Dr. Ila Jain @Dr. Tanmoy Ganguly @Dr. Suhela Rachakonda @Dr. Yashaswini P Shanmugam Kindly give your valuable opinions. Thank you. Best regards.

Respected sir, kindly consider posting fig 10 image in high power (to know whether it is fibrin with entrapped cells or stromal fragment). Regards...

tumor cells are arranged in small to large clusters,cells showing round to oval nucleii with bland chromatin.Spindle cells and oncocytic like cells are also seen.fibromyxoid background is seen. Impression -pleomorphic adenoma with oncocytic change

based on gender(female), age and disease progress , d diagnosis points towards benign growth with pleomorphic adenoma being the most common..(cellular pattern explained by pathologist dr usha)

Hyper chromatic nuclei seen, parotid tumour, malignant, D/D- lymphadenitis, benign parotid tumour.

@Dr. Sivaganesh Porko @Dr. Tanmoy Ganguly @Dr. Usha Amliyar sirs and madams posted additional images for your opinions. Thanks.

Respected sir, after seeing the additional images I am really confused. There are hardly any acini, sheets of ductal epithelial cells and stromal component composed of adipocytes and fibrovascular component. ( some appear as fibromyxoid too). And obviously there are debris as evidenced in additional images 6,7. Oncocytic change is not so prominent in additional images. Also substantial degree of atypia is noted too. Now it looks more on a suspicious for malignancy, but it is quite difficult to subtype sir. If possible take a radiologist opinion and repeat under US guidance. Thank you sir. I definitely can't come to a conclusion on this, sir... Sorry....

H/O- 52yrs/F; parotid swelling unilateral for 8mnths; mildly tender soft to firm; blood aspirated. Microscopy-Smears are cellular and showing ductal epithelial cells arranged in sheets, branch and acini formation. The cells are plygonal with distinct cell border, eosinophilic granular cytoplam, round to oval nucle and stippled chromatin. Myoepithelial cells are seen. No malignant cells seen. Opinion- Benign Parotid tumor, likely Oncocytoma.

Hi.sir..smears from parotid swelling shows moderate cellularity.the cells are are arranged in sheets and small clusters .They have moderate eosinophilic cytoplasm ,round to oval nuclei with bland chromatin. in pap myoepithelial cells are also seen. so it is benign parotid tumour.most likely.oncocytoma..advice: confirm with hp report if invasion there or not

dear sir , thanks for tagging me in this post cellular features were beautifully explained by dr porko, I too initially thought as oncocytoma, but considering the age and few images fig 5 , having attempted acinar configurations and few cells with finely vacuolated cytoplasm I offer my diagnosis as Acinic cell carcinoma. thank you sir.

Additional image. (12)

I meant this image sir...
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