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Journal of Dental Sciences
University
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 03
University J Dent Scie 2017; No. 3, Vol. 1
Research Article1 2 3 4 5 Amrita Raj ,Amit Pandey , Ankita Raj , Gauri Mishra , Abhinav Misra , Saket Nigam
1. Reader, Department of Oral and Maxillofacial Pathology, Rama Dental College, Hospital & Research Centre, Kanpur. 2. Reader, Department of Periodontology and Oral Implantology, Rama Dental College, Hospital & Research Centre, Kanpur.3. Reader, Department of Oral and Maxillofacial Surgery, Rama Dental College, Hospital & Research Centre, Kanpur.4. Associate Professor, Department of Dentistry. Government Medical College Jalaun, Orai. 5. Associate Professor, Department of Dentistry. Government Medical College, Kannauj. 6. Associate Professor, Department of Radiodiagnosis, Rama Medical College, Mandhana, Kanpur.
INTRODUCTION : Fine needle aspiration cytology
(FNAC) is a well established diagnostic tool for the lesions of
the head and neck region, especially for swellings in the
thyroid gland, salivary gland, and lymph nodes. Preoperative
aspiration cytology can be practiced on almost any anatomic
region evident visually. [1] The goal of FNAC is to yield
diagnosis by causing minimum tissue trauma and producing
quick results. It can obviate the need for surgery in non-
neoplastic conditions or inflammatory lesions and metastatic
tumors. Its low cost, minimal morbidity, rapid turn around
time and relatively high sensitivity and specificity makes it a
useful method of evaluating suspicious masses in outpatient
and hospital setting.
FINE NEEDLE ASPIRATION CYTOLOGY IN OROFACIAL SWELLINGS- A USEFUL TOOL
Keywords-
Source of support : Nil
Conflict of interest: None
Fine needle aspiration
cytology, FNAC,
Oropharyngeal Lesions,
Diagnostic Accuracy,
Oro-facial Swellings.
ABSTRACT: Fine needle aspiration cytology (FNAC) is a well established diagnostic tool for
the lesions of the head and neck region, especially for swellings in the thyroid gland, salivary
gland, and lymph nodes. Preoperative aspiration cytology can be practiced on almost any
anatomic region evident visually. The goal of FNAC is to yield diagnosis by causing minimum
tissue trauma and producing quick results. Fine needle aspiration cytology (FNAC) of oral and
maxillofacial region has not been widely utilized for diagnosis due to diversity of lesion types,
heterogeneity of cell populations and difficulties in reaching and aspirating these lesions.
Aim: The purpose of the current study was to evaluate the diagnostic accuracy, sensitivity, and specificity of Fine needle aspiration cytology (FNAC) in tumors and tumor-like conditions in the oral and maxillofacial region.
Materials and method: The study was conducted on 62 patients of both sexes and all age groups, with clinically diagnosed tumors and tumor-like conditions of oral and maxillofacial region, with the oro-facial swellings. A comparison between cytological and histological diagnosis was done wherever biopsy material was available.
Results: In present study of 62 cases excluding 3 cases with unsatisfactory smear, The Diagnostic accuracy was 88.13%, Sensitivity 97.05%, Specificity 90.47%, Positive predictive value 94.28% and, Negative predictive value 95%.
Conclusion: FNAC is a minimally invasive, highly accurate and cost-effective procedure for the assessment of patients with oromaxillofacial lesions. The present study illustrates the role of FNAC in the diagnosis of a variety of benign as well as malignant lesions of the oral cavity and oropharynx. The deeply situated oral / oropharyngeal lesions are difficult to aspirate, still FNAC is highly accurate especially for the malignant lesions which can be of great help in early planning of the definitive course of management. However, specific cytological diagnosis may be difficult to make in the absence of characteristic architectural patterns.
FNAC of oral and maxillofacial region has not been widely utilized for diagnosis due to diversity of lesion types, heterogeneity of cell populations and difficulties in reaching and aspirating these lesions. [2] The purpose of the current study was to evaluate its diagnostic accuracy, sensitivity, and specificity in tumors and tumor-like conditions in the oral and maxillofacial region.
MATERIAL AND METHODS
The study was conducted on 62 patients of both sexes of all
age groups, with clinically diagnosed tumors and tumor-like
conditions of oral and maxillofacial region, with the oro-
facial swellings. The patients were selected from the indoor
and outdoor department of Rama Dental College, Hospital
and Research Center, Kanpur, Rama Medical College,
Kanpur, J.K.Cancer Institute, Kanpur.
The FNAC was performed using 21–25 G needle and a 20-ml
syringe with or without local anesthetic, as and when
required. The lesional site was swabbed, using povidine-
iodine solution and ethyl alcohol (spirit). The needle was
inserted into the lesion and aspirate from different portions of
the mass lesion was collected by altering the direction of the
needle inside the mass and by giving multiple passes. The
aspirated material so obtained was smeared onto glass slide
[75x25mm]. Air-dried smears were stained with May-
Grünwald Geimsa (MGG) stain and smears fixed in 95%
ethanol were stained with hematoxylin and eosin (H& E) /
Papanicolaou (PAP) stains. Special stains like Ziehl-Neelsen
and periodic acid-Schiff (PAS) were performed in accordance
with the type of lesion and requirement. Cytopathological
diagnosis was made and correlated with histopathological
diagnosis wherever biopsy was possible. Complete
requisition form was filled, mentioning the clinical details.
Procedure-related minor complications in the form of
prolonged bleeding were noted in a few of the patients;
however, no major complications were seen.
RESULTS AND OBSERVATIONS
Fine needle aspiration was performed on 62 patients (Table 1, Graph 1), out of which, a definite positive diagnosis of malignant or benign lesion was given in 57 cases (91.93%). Histopathological correlation was possible in 44 cases. Out of these 57 cases, 37(59.67%) were proved to be malignant and 20(32.25%) were benign on biopsy. On cytology, two cases were signed out as suspicious for malignancy and three cases were unsatisfactory because of inadequate material for which tissue was not available.
TABLE 1: Showing categorization of total orofacial
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 04
University J Dent Scie 2017; No. 3, Vol. 1
Category Reported Cases
n (%)
Benign 20 (32.25)
Malignant 37 (59.67)
Suspicious 02 (3.3)
Inadequate 03 (4.83)
Total 62 (100)
aspirations performed.
GRAPH 1: Showing categorization of total orofacial
aspirations performed
On considering various sites (Table 2), a total of 54 cases
were reported from within oral cavity, of which 16 were
benign and 33 turned out to be malignant. Two out of three
cases from lymph node area were benign. Three cases were
reported from salivary glands of which 1 was malignant and
from the tonsillar area, 2 cases were reported both being
carcinomas.
TABLE 2: Showing Cyto-diagnosis of various lesions
/sites
On comparing the cytodiagnosis with histopathology (Table
3), Squamous cell carcinoma was reported on cytodiagnosis
in twenty eight patients which was histopathologically
confirmed in twenty seven cases, whereas in one case only
benign necrotic tissue was seen. Giant cell lesion was reported
in three patients which were confirmed by histopathology as
giant cell granulomas. Adenoid cystic carcinoma of minor
salivary glands was reported in three patients which was
histopathologically confirmed in two patients whereas one
turned out to be adenoma. Eight cases were reported as
odontogenic lesions of which three were reported as
ameloblastoma, three as OKC, one as radicular cyst and one
as benign inflammatory tissue on histopathology. Five cases
were reported as benign inflammatory tissues of which one
was histopathologically confirmed as malignant carcinoma.
Sr No Site ofFNAC
Total no. of cases
Benign Malignant Suspicious Inadequate
1 Oral cavity 54 16 33 02 03 2 Lymph node 03 02 01 00 00
3 Salivary gland
03 02 01 00 00
4 Tonsillar region
02 00 02 00 00
5 Total n (%) 62 20 (32.25)
37 (59.67) 02 (3.3) 02 (4.83)
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 05
University J Dent Scie 2017; No. 3, Vol. 1
One case was reported as melanoma which was confirmed
histopathologically as malignant melanoma. In major
salivary glands, a total of three cases were encountered of
which two were benign and one was malignant. Benign cases
were confirmed histopathologically but for the malignant
lesion, the histopathology was not available. From the
tonsillar area two cases were reported both cytologically as
malignant lesion which was confirmed by histopathology.
One metastatic lymphnode was reported and confirmed by
histopathology.
TABLE 3: Showing distributions of cases according to site
and corealation of FNAC with histopathological findings.
On comparing the results of fine needle aspiration cytology to
histopathologically confirmed cases in various sites (Table 4),
of total sixty two patients, fifty seven patients were diagnosed
of which fifty two were confirmed by histopathology. Two
cases were false positive which were given as carcinomas on
cytodiagnosis but turned out to be benign on histopathology.
Sr no Nature of lesion No of cases diagnosed by FNAC
Histological Diagnosis
No of cases confirmed by histology
Oral cavity 1 Squamous cell
carcinoma 28 Squamous cell
carcinoma 27 01
Benign necrotic inflammation
2 Giant cell lesion 03 Giant cellgranuloma
03
3 Adenoid cystic carcinoma of minor salivary glands
03 Adenoma 01 02
Adenoid cystic carcinoma
4 Acute inflammatory lesion
05 Acute inflammatory lesions
04 01
Squamous cell carcinoma
5 Odontogenic lesion 08 Ameloblastoma 03 03 01 01
Odontogenic Keratocyst Radicular cyst
Benign inflammatory tissue
6 Melanoma 01 Melanoma 01
7 Sarcoma 01 Histology not available
01
8 Suspicious 02 Histology not available
02
9 Inconclusive 02 Histology not available
02
Lymphnodes 1 Metastatic (Squamous
cell) carcinoma 01 Confirmed 01
2 Tubercular lymphadenitis 02 Confirmed 02
Tonsillar region
1 Tonsillar carcinoma 02 Carcinoma 02
Salivary glands 1 Pleomorphic adenoma 01 Confirmed 01
2 Pleomorphic adenoma ex-carcinoma
01 Histology not available
01
3 Sialadenitis 01 Confirmed 01
TABLE 4: Showing overall results of FNAC at different
sites
Tables show a comparison between benign and malignant
cases given on FNA with their respective histological
diagnoses.
TABLE 5: Showing diagnostic accuracy of FNAC at
different sites.
On comparing the overall accuracy rate (Table 5), 88.23%
accuracy rate was seen in the oral cavity and 66.66% in the
salivary glands where as in l the other sites the rate was 100%,
which may be due to the small sample size. The sensitivity in
the oral cavity was 96.77% whereas in all the other sited it was
99.3% and the specificity was seen to be 93.75% in the oral
cavity and 66.66% in salivary gland whereas 100% in other
two sites.
Table 6: Overall diagnostic accuracy of FNAC of
Orofacial swellings.
Of the total sixty two aspirations done (Table 6), diagnosis by
FNAC was possible in fifty seven cases, of which fifty two
were confirmed by histopathology. Nineteen cases were
Sr no Site & nature of lesions
Total no of cases
No of cases diagnosed by FNAC
No of cases confirmed by histology
Unsatisfactory /Inconclusive
False positive
False negative
Suspicious
1 Oral cavity
· Benign · Malignant
54 49 16 33
45 15 30
03 01 01 02
2 Lymph node
· Benign · Malignant
03 03 02 01
03 02 01
-- -- --
3 Salivary gland
· Benign · Malignant
03 03 02 01
02 02 00
-- 01 --
4 Tonsillar region
· Benign · Malignant
02 02 00 02
02 00 02
-- -- --
5 Total 62 57 52 03 02 01 02
Sr no
Site of aspiration
No of cases confirmed by histology
Overall accuracy TP+TN/(total cases)x100
Sensitivity TP/(TP+FN)x100
Specificity TN/(TN+FP)x100
1. Oral cavity 45 88.23 96.77 93.75
2. Lymph node
03 100 99.3 100
3. Salivary gland
02 66.66 99.3 66.66
4. Tonsillar region
02 100 100 100
Sr No Diagnostic accuracy Total no.
1 Total No. of aspirations done 62
2 Total No. of cases diagnosed by FNAC 57
3 Histological correlation possible in 52
4 Total No. of true negative cases 19
5 Total No. of true positive cases 33
6 Total No. of false positive cases 02
7 Total No. of false negative cases 01
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lesions, is available but only few reports, however, explore the
potential of Fine needle aspiration cytology for the diagnosis of intraoral and lesions of maxillofacial region.[4] The
various cytological target areas of orofacial lesions include
cheeks and lips, jaws, intraoral mucosa, tonsils and tongue,
salivary glands and lymph nodes. On considering various
sites, of total 62 cases, 54 were encountered within the oral
cavity, and a diagnosis by FNAC was made on 49 cases, of
which 16 were benign and 33 were malignant.
ASPIRATION OF LYMPH NODES:
Lymph nodes are commonly aspirated masses in head and
neck region. They are important component of peripheral and
secondary lymphoreticular tissue, react to various
pathological stimuli, resulting in their enlargement, which
may be considerable, sometimes. Aspiration from lymph
nodes requires no radiological guidance and can be very
useful in diagnosing metastatic carcinomas, extent and
recurrence of lymphomas, inflammatory conditions like
tuberculosis, non specific lymphadenitis, and in providing
material for culture and other studies.
The group with the best diagnostic accuracy on
cytohistological correlation was carcinoma metastatic to the
lymphnodes (100%). Schour and Qiu in [5] 1972 reported the
accuracy of 97% in carcinoma metastatic to lymphnodes.
They constitute one of the commonest indications for FNAC
and in this cytological diagnosis can be easily obtained. Along
with the malignancy, the nature and the site of the primary can
also be given in most of the cases.
Results of tubercular lymphadenitis as per Gupta et al [6] in
1991 shows the accuracy of 76.78% however, definitive
diagnosis is difficult in cases where Langhan's giant cells and
epitheloid cells are not seen in the smears. Also they may
contain only casseous material or pus. Our results showed
100% accuracy but that may be due to less number of cases
encountered. The cytological smear revealed the presence of
langhan's giant cells. (Fig-01)
FIG 01: FNAC smear of tubercular lymphadenitis showing
identified as True Negative and thirty three as True Positive.
Two cases were False Positive and one was False Negative.
TABLE 7: Showing validity of FNAC in Orofacial
swellings.
Accordingly, the overall diagnostic sensitivity, specificity,
positive predictive value, and negative predictive value of
FNAC of orofacial swellings (Table 7) was found to be
97.05%, 90.47%, 94.28%, 95% respectively and the overall
accuracy was found to be 88.13%.
DISCUSSION
Fine needle aspiration cytology as practiced today, is an
interpretative art with histopathology as its scientific base. Its
practice is quite different from that of either exfoliative
cytology or surgical pathology. Unlike histopathology where
tissue pattern, cell morphology, intercellular products and
inter cellular matrix are preserved, in cytology it is mainly the
cell morphology which is preserved.
The fundamental indication for FNAC is a lesional mass that is palpable or visible by a radiological imaging method. This technique may also assist in establishing a specific diagnosis for radiolucent lesions of the jaw. The thinning or destruction of cortical bone permits the use of thin needles to aspirate such abnormalities.[2]
Fine needle aspiration cytology was performed on sixty two patients with various palpable lesions in the orofacial region. Fifty seven (96%) aspirations were considered to be satisfactory of which 20(32.25%) were benign and 37(59.67%) were diagnosed as malignant, three were considered inadequate as were hypocellular and two cases were considered suspicious for malignancy but aspirate consisted of only blood.
In present study of 62 cases excluding 3 cases with unsatisfactory smear, the Diagnostic accuracy was 88.13%, Sensitivity 97.05%, Specificity 90.47%, Positive predictive value 94.28% and, Negative predictive value 95.0%. On comparing the results of the present series with other workers it can be said that the result of this study compare favorably with those published in literature and are fairly accurate.
FNAC of head and neck region was pioneered by Martin in
the early 1930s. [3] A relatively large volume of literature,
documenting the effectiveness of Fine needle aspiration
cytology for diagnosis of head and neck and salivary gland
Measure of validity Results (%)
Sensitivity 97.05
Specificity 90.47
Overall accuracy 88.13
Positive predictive value 94.28
Negative predictive value 95.00
lymphocytes, foamy macrophage, plasma cells and one area
of the smear shows one langhan's giant cell.
Cytology of non-Hodgkins lymphoma can be confused with
reactive hyperplasias and may not be a suitable tool in
forming the diagnosis as stated by Frable [7] in 1979. The
exclusion or confirmation of malignant lymphoma is of
practical importance and may obviate in surgical excision.
ASPIRATION OF ORAL CAVITY, PHARYNX AND
JAWS:
The target areas of orofacial regions are cheeks and lips, jaws,
mucosa (masticatory mucosa, lining mucosa and specialized
mucosa of tongue), tonsils, salivary glands, and lymph nodes.
The data from the population based cancer registries in India
shows the malignant tumors of Lips, Oral Cavity, and Pharynx
are the most common group of cancers. Squamous Cell
Carcinoma is the most common oral malignant neoplasm as
also found in this study 45.16% in total 62 cases of this region,
and the most common site was found to be cheeks and angle of
the mouth. Cytological smears revealed the presence of
atypical cells and later histopathological diagnosis confirmed
squamous cell carcinoma.
Orofacial lesions are readily accessible to FNAC and the
proximity of tissues of various types and wide range of
primary and metastatic neoplasm are responsible for this site
being the most interesting in Fine needle aspiration diagnosis.
The confirmation of the metastatic spread to lymph nodes can
be amongst the easiest of diagnosis variation in the
appearance of even common type of primary neoplasm like
salivary gland tumors makes this a challenging and difficult
area.
Cheeks, lips and face:
There are many cystic, infective and neoplastic conditions of
this region which are easily diagnosed by FNAC. Benign
lesion like dermoid cyst, epidermal cyst to neoplasm like
hemangiomas and malignant lesions like basal cell
carcinoma, lymphomas, squamous cell carcinoma and rarely
melanomas are encountered in this area and can be easily
diagnosed by FNAC.
Feldman et al [8] in 1983 discussed FNAC in squamous cell
carcinoma of head and neck, and problem of differentiating it
cytologically from congenital cyst and other cysts having
squamous lining epithelium. Kiran Alam [9] in 2009, studied
efficacy of Fine needle aspiration cytology of head and neck
masses, where aspiration was done in 74 patients and their
cytohistological correlation were done. The sensitivity and
specificity of FNAC in pediatric head and neck masses was
found to be 95.65 and 93.3% respectively.
Squamous cell carcinoma as also found in this study 45.16%
in total 62 cases of this region, and the most common site was
found to be cheeks and angle of mouth. Of twenty eight cases
that were reported as squamous cell carcinoma on FNAC,
twenty seven were confirmed on histopathology. The smear
show dysplastic cells (fig- 2A, 2B & 2C). The squamous cell
carcinoma of this area is usually associated with secondaries
in lymphnodes, submental, submandibular or cervical group.
In many cases patient present with cervical lymphadenopathy
showing metastasis with hidden primary which may be
usually found in pharyngeal and laryngeal area. In such cases
FNAC can be of great help.
FIG 02A: Pap stained smear of SCC, showing
dedifferentiated cells
FIG 02B (i & ii): Giemsa stained smear showing atypical
squamous cells showing hyperchromatism, nuclear and
cellular pleomorphism and atypical mitosis, confirmed by
histopathology
FIG 02C: H&E stained smear showing dysplastic cells
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the aspirates as stated by Gunhan et al[12] in 1993.
According to Mathew [13] in 1997, the odontogenic tumors
like ameloblastomas can be correctly diagnosed by FNAC.
He defined and elaborated the cytomorphological features of
primary and metastatic ameloblastoma on fine needle
aspiration and to discuss the differential diagnosis with
closely related entities. He found hypocellular smears with
occasional basaloid cells having peripheral palisading. He
characteristically found two cell populations, consisting of
small hyperchromatic basaloid cells and large cells with more
open chromatin. Mesenchymal cells with more elongated
nuclei and ample, clear cytoplasm were also noted. Malignant
cases showed prominent cytologic pleomorphism, cellular
crowding and high mitotic/ karyorrhectic index. He
concluded that with proper radiological evidence, the
cytological features of primary and metastatic ameloblastoma
are unique. Diagnostic problems may arise when these lesions
are pleomorphic and frankly malignant, especially at the
metastatic sites such as lungs.
Gausia Rahim[14] also found FNAC as a valuable tool in initial diagnosis for primary ameloblastoma where the smears depicted basaloid epithelial cells in sheets and clusters with scanty, poorly defined cytoplasm, elongated nuclei, finely distributed chromatin and inconspicuous nucleoli in ameloblastoma. Smears showed showed fragments depicting nests and cords of cells in a fibroblastic stroma. The cell groups showed peripheral palisading and stellate reticulum in the centre although no nuclear atypia or mitotic figures were evident. FNAC is not usually the first diagnostic method in these lesions, as incisional biopsy is easily and rapidly carried out. Nevertheless, the cytological study can be very useful in cases of metastatic disease or in the follow up of possible recurrences.[15,16] Also a prior cytological diagnosis ensures adequate excision with uninvolved margins which definitely prevents recurrence.
However, in our study of 08 cases of odontogenic tumors we
could only find inflammatory cells in the aspirate with few
basaloid cells. Of these 08 cases, 03 cases were diagnosed as
ameloblastoma, 03 as keratocystic odontogenic tumor, 01 as
radicular cyst and 01 as inflammatory tissue. Although tumor
typing of odontogenic tumors was not possible through
FNAC in our study, it can be used as tool to rule out
malignancy.
Salivary glands
A lot of work has been done on FNAC of salivary glands in the
past with varying results. FNAC forms a useful tool in
diagnosing intrinsic salivary gland lesions and to differentiate
Fig 03: FNAC smear showing atypical melanocytes with
anisocytosis, anisonucleosis.
JAWS
Lytic lesions of the jaw are readily accessible to FNAC with
radiographic control. Giant cell granulomas produce spindle
cells and multinucleated giant cells. Hemosederin is present
in Brown tumor of parathyroid that also yields multinucleated
giant cells. In our study three cases were reported as giant cell
lesion on FNAC were confirmed as giant cell granulomas on
histopahology.
Aspirates of cystic bone lesions yield more material than firm
lesions do. However, it is reported that, the diagnosis of
aspirates from cystic lesions may be difficult and less specific
than the FNAC diagnosis of solid lesions due to the paucity of
specific lesional cells and also chances for superimposed
infection. A diagnosis of 'benign cystic lesion' is justified in
many instances. [10] Ramzy et al[11] in 1985 presented their work on radiolucent
lesions of the jaws, making diagnosis in most of the lesions by
fine needle biopsy. Omar Gunhan [12] in 1993 did FNAC
various cystic, inflammatory and neoplastic lesions of jaws
and found their results specific in 92% of malignant and 97%
of benign lesions.
Melanoma, a malignant neoplasm of melanocytic origin, has
low rate of occurrence in the oral cavity with the incidence
being less than 1%. It has aggressive nature and high rate of
metastasis. Biopsy is contraindicated due to the
aggressiveness and rapid spread. We found a case with
extensive involvement of palate and maxillary attached
gingival. The FNAC smear showed malignant cells with
pigment, and the metastatic lymph nodes were positive for
malignant cells (Figure 03).
Odontogenic cyst contains anucleated and superficial
squamous cells. Odontogenic tumors like ameloblastoma
yield basaloid cells in sheets and keratinized squamous cells.
Cytologically, varying proportions of inflammatory cells,
histiocytes, clusters of mature squamous cells, columnar or
cuboidal cells, keratin lamellae and cyst fluid can be seen in
University Journal of Dental Sciences, An Official Publication of Aligarh Muslim University, Aligarh. India 09
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salivary gland from non salivary gland masses. Pleomorphic
adenoma is the commonest of all salivary gland tumors.[17]
The aspirates reveals fibrillary chondromyxoid ground
substance and epithelial cells, single and in poorly cohesive
clusters and sheets. Cells have regular ovoid nucleus with
bland nuclear chromatin and well defined cytoplasm.
Orell[18] in 1995 discussed the difficulties in interpretation of
FNAC of salivary glands. He described hyaline stromal
globules resembling those characteristic of adenoid cystic
carcinoma or beaded hyaline stroma in pleomorphic
adenoma. Epithelial cells showing nuclear enlargement,
abnormal nuclear chromatin, nucleolar prominence,
epihthelial cells in a fibromyxoid stroma raise a suspicion of
carcinoma arising in pleomorphic adenoma.
Coexpression of glial fibrillary acid proteins, keratin and
vimentin is a unique feature useful in diagnosis of
pleomorphic adenoma in FNAC smears. [19]
Mucoepidermoid carcinoma has a bimorphic glandular and
squamous structure. Acinic cell carcinoma smears contain
abundant cellular material against a clean background. The
cells appear cohesive and very well differentiated with
granular cytoplasm and medium sized nuclei with little
evidence of pleomorphism.[20] Minor salivary gland tumors
in the oral cavity account for about 15% of all salivary gland
tumors. PLGA is seen almost exclusively in the minor
salivary glands. Gibbons et al[21] described this tumor as
having architectural diversity but cytological uniformity. Two
cases of PLGA were misdiagnosed as ACC and PA in their
study initially. It is important to differentiate PLGA from
more aggressive tumors like ACC. Differentiation of PA from
ACC may pose problems at times in cytology. Cerulli 2004
[22] studied 24 patients with pleomorphic adenoma and
adenoid cystic carcinoma of minor salivary glands of palate,
and found definitive histopathologic results in 22 of 24 cases.
We reported three cases in the major salivary gland of which
one was reported as pleomorphic adenoma, one as sialdenitis
and one as ex carcinoma pleomorphic adenoma.
Histopathology could not be done for ex carcinoma
pleomorphic adenoma while the other two were confirmed by
histopathology. The overall diagnostic accuracy in this group
was found to be 66.66% but the sample size was small in our
study. Three cases were found intraorally and were reported as
malignant adenoid cystic carcinoma. However, only two were
confirmed as adenoid cystic carcinomas.
A variety of non-neoplastic and neoplastic lesions can involve the oral and oropharyngeal cavity and these are common lesions encountered in clinical practice. FNAC can prove to
be helpful in the diagnosis of clinically non-characteristic lesions. The first aim of FNAC is to detect if the lesion is malignant or benign. Also the specific diagnoses of the lesions by examining their cellular properties on the cytological specimen can be done and it practically has no contraindications.
The FNAC is a non-traumatic and a cost-effective procedure and can provide a simple and safer alternative to open biopsy with a low morbidity rate. The technique does not require much equipment. In the present study, there were not any complications related with FNAC. FNAC materials also p e r m i t t h e s u p p l e m e n t a r y s t u d i e s s u c h a s immunohistochemistry, electron microscopy, morphometric studies for diagnosis of specific typing of lesions. [23]
CONCLUSION
The present study illustrates the role of FNAC in the diagnosis of a variety of benign as well as malignant lesions of the oral cavity and oropharynx. Information on the biological behaviour of a lesion in the preoperative period is very important and FNAC forms a good starting point for the diagnosis. The deeply situated oral/oropharyngeal lesions are sometimes difficult to aspirate. FNAC is highly accurate for the malignant lesions which can be of great help in early planning of the definitive course of management. However, specific cytological diagnosis may be difficult to make in the absence of characteristic architectural patterns. Diagnosis of aspirates from cystic lesions may be less specific as compared to solid lesions due to paucity of specific lesional cells and also there can be superimposed infection. Based on overall results and rarity of false positive FNAC results in our study, we support the use of Fine needle aspiration cytology in diagnosing lesions of oral and maxillofacial region.
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