Gailey Michael P, Bayon Rodrigo, Robinson Robert A
Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Diagn Cytopathol. 2014 Dec;42(12):1085-90. doi: 10.1002/dc.23111. Epub 2014 Feb 18.
Cribriform adenocarcinoma of minor salivary gland (CAMSG) is a recently characterized low grade salivary gland malignancy that most commonly presents as a mass in the base of the tongue, frequently with regional lymph node metastasis. Given its relative rarity and overlapping cytomorphology, CAMSG may be confused with polymorphous low grade adenocarcinoma (PLGA) in minor salivary gland sites and papillary thyroid carcinoma (PTC) in cervical metastasis, in both fine-needle aspiration and excisional specimens. As there are no cytology reports in the literature, we present two new cases of CAMSG and describe the aspiration cytology of the tumor taken from bench top aspirates, compare it with the histomorphology, and discuss the features that may help one avoid misdiagnosis of PTC in the setting of cervical lymph node metastasis. We found that like PTC, aspirates of CAMSG contain polymorphic fragments of epithelial cells arranged in monolayer sheets, papillary fronds and tips, and occasional cribriform configurations, and metachromatic stromal fragments, which may be misinterpreted as colloid. A background of myxoid/mucoid material also reminiscent of colloid was prominent. Differentiation from PLGA is more difficult based strictly on cytology. A review of the most current literature in relation to the molecular and immunohistochemical profiles, therapeutic options, and prognosis is also presented. It is critical for pathologists and clinicians to be aware of this tumor when presented with patients having a cervical lymph node mass in the absence of a primary tumor.
小涎腺筛状腺癌（CAMSG）是一种最近才被明确特征的低级别涎腺恶性肿瘤，最常见的表现是舌根部肿块，常伴有区域淋巴结转移。鉴于其相对罕见以及细胞形态学上的重叠，在细针穿刺活检和切除标本中，CAMSG在小涎腺部位可能会与多形性低级别腺癌（PLGA）混淆，在颈部转移时可能会与甲状腺乳头状癌（PTC）混淆。由于文献中没有细胞学报告，我们报告两例新的CAMSG病例，并描述从台式穿刺物中获取的肿瘤的穿刺细胞学特征，将其与组织形态学进行比较，并讨论有助于避免在颈部淋巴结转移情况下误诊为PTC的特征。我们发现，与PTC一样，CAMSG的穿刺物包含排列成单层片、乳头样叶和尖端的上皮细胞多形性碎片，偶尔还有筛状结构，以及异染性基质碎片，后者可能被误解为胶体。黏液样/黏液物质的背景也很突出，让人联想到胶体。严格基于细胞学来与PLGA区分则更困难。本文还对与分子和免疫组化特征、治疗选择及预后相关的最新文献进行了综述。对于病理学家和临床医生而言，当面对没有原发肿瘤但有颈部淋巴结肿块的患者时，了解这种肿瘤至关重要。
