n
FNA Findings
nFNA
repeated to reveal
-
nFew drops of semisolid murky or brown cloudy fluid
nCharacteristic mixture of n
- Large eosinophilic ep cells in sheets & honeycombed patterns, or even as singly scattered cells
-
nNumerous inflammatory cells like macrophages lymphocytes & degenerated cells
-
nMast cells (Giemsa & Toludine blue stains)
-
nAcellular granular proteinaceous debris
-
nDirty amorphous or granular debris in background
- Metastatic Squamous Cell Carcinoma
- Warthin's Tumour
n
What is ‘for’ & ‘against’ Sq Ca?
FOR
-
nBilaterality
-
nDirty background with lymphoid cells & debris
-
nSquamoid cells
nAGAINST
-
nCells are rounded
-
nCells are in flat sheets
-
nRegimented cells at periphery of sheets
-
nCytological features of malignancy are dubious
|
Cytomorphology of Warthin's Tumor |
|
|
Presentation
|
Cystic mixed with
lymphoid cells & oncocytic cells. Can be bilateral
|
|
Arrangement
|
Isolated or loosely
cohesive groups, sheets or branching/papillary tissue fragments
|
|
Cells
|
Large cuboidal to
polygonal or columnar with well defined borders
|
|
Nucleus
|
Uniform central
location, smooth membrane, granular chromatin, macronucleolus, low N/C
|
|
Cytoplasm
|
Abundant granular or
sometimes clear
|
|
Background
|
Mucoid lymphoid cells
with germinal centers amorphous debris degenerated cell, sq metaplasia
|
Pitfalls and Misdiagnosis
-
n
Ep cells may be mistaken for Sq Ca with the dirty background
-
nGranular cytoplasm of cells can mimic Acinic Cell Ca.
-
nIn absence of cellularity, may be mistaken for a simple inflammatory cyst
-
nOcc. misdiagnosed as Branchial cleft cyst
-
nMistaken for Oncycytoma (Oxyphilic Adenoma)
|
Features that result in misinterpretation
|
Diagnostic entities mistaken for
|
|
Predominant lymphoid stroma with sparse epithelial cells
|
Benign lympho-ep cyst/lesion
Chronic sialadenitis
|
|
Mucoid stroma
Squamous metaplasia
|
Mucoepidermoid carcinoma
Metastatic Sq Ca
|
|
Predominant oncocytic component
|
Oncytoma
Warthin’s Tumor
|
|
Murky
background with degenerating cells & debris
|
Malignancies esp Metastatic Sq Ca
|
Warthin's Tumor