Handa Uma, Dhingra Neerja, Chopra Rajan, Mohan Harsh
Department of Pathology, Government Medical College and Hospital, Chandigarh, India.
Diagn Cytopathol. 2009 Jan;37(1):11-5. doi: 10.1002/dc.20951.
The diverse morphological features encountered in pleomorphic adenoma (PA) may cause diagnostic errors in fine needle aspiration cytology (FNAC). The present study was performed to evaluate the variations in the cytological features of pleomorphic adenoma and to assess the efficacy of FNAC in its diagnosis. Fifty cases diagnosed as PA on FNAC were retrieved from the records of the Pathology Department. Cytologic smears and sections were reviewed and the cytologic diagnoses were compared with the definitive histologic diagnoses. In cases correctly diagnosed on aspiration, morphological variables like patterns of the epithelial component, type and extent of the mesenchymal matrix, metaplastic cells, hyaline globules, cystic change, giant cells, crystalline deposits, nuclear inclusions/grooves, and nuclear atypia were evaluated. The extreme diversity in morphologic features seen in histologic sections was reflected in the smears of PA. Metaplastic changes were observed more frequently in sections, while nuclear changes like inclusions/grooves were more commonly seen in smears. Other morphological features like cylindromatous pattern, giant cells and crystalline deposits were observed with equal frequency in smears and sections. Cytohistologic agreement was present in 45 of the 50 cases (90%). In 5 cases diagnosed as pleomorphic adenoma on FNAC, the histology revealed 1 case each of schwannoma, perineurioma, ectomesenchymal chondromyxoid tumor of tongue, adenoid cystic carcinoma and mucoepidermoid carcinoma. FNAC is a fairly accurate pre-operative procedure for the diagnosis of PA. The cytopathologist needs to be aware of the cytologic variations in pleomorphic adenoma so as to avoid diagnostic errors.
多形性腺瘤（PA）中出现的多样形态特征可能会在细针穿刺细胞学检查（FNAC）中导致诊断错误。本研究旨在评估多形性腺瘤细胞学特征的变化，并评估FNAC在其诊断中的有效性。从病理科记录中检索出50例经FNAC诊断为PA的病例。对细胞学涂片和切片进行复查，并将细胞学诊断与最终组织学诊断进行比较。在穿刺诊断正确的病例中，评估上皮成分的模式、间充质基质的类型和范围、化生细胞、透明小球、囊性变、巨细胞、结晶沉积物、核内包涵体/沟以及核异型性等形态学变量。组织学切片中所见形态特征的极端多样性在PA的涂片中也有体现。化生改变在切片中更常见，而核内包涵体/沟等核改变在涂片中更常见。其他形态学特征如圆柱瘤样模式、巨细胞和结晶沉积物在涂片和切片中的出现频率相同。50例病例中有45例（90%）存在细胞组织学一致性。在5例经FNAC诊断为多形性腺瘤的病例中，组织学检查显示分别为神经鞘瘤、神经束膜瘤、舌外胚间叶性软骨黏液样肿瘤、腺样囊性癌和黏液表皮样癌各1例。FNAC是诊断PA的一种相当准确的术前检查方法。细胞病理学家需要了解多形性腺瘤的细胞学变异，以避免诊断错误。
