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A Dissertation on CYTOLOGIC SPECTRUM of SALIVARY GLAND

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A Dissertation on CYTOLOGIC SPECTRUM of SALIVARY GLAND A Dissertation on CYTOLOGIC SPECTRUM OF SALIVARY GLAND LESIONS WITH HISTOPATHOLOGICAL CORRELATION Dissertation submitted to THE TAMILNADU Dr.M.G.R MEDICAL UNIVERSITY CHENNAI-600032 In Partial fulfillment of the regulations Required for the award of M.D.Degree in PATHOLOGY (BRANCH III) DEPARTMENT OF PATHOLOGY COIMBATORE MEDICAL COLLEGE MAY 2020 UNIVERSITY REGISTRATION NO: 201713251 DECLARATION I solemnly declare that the dissertation titled “CYTOLOGIC SPECTRUM OF SALIVARY GLAND LESIONS WITH HISTOPATHOLOGICAL CORRELATION” was done by me at Coimbatore Medical College, during the period 2018 -2019 under the guidance and supervision of Prof.A.DHANALAKSHMI, MD., to be submitted to The Tamilnadu Dr.M.G.R.Medical University towards the partial fulfilment of requirements for the award of MD DEGREE in PATHOLOGY BRANCH –III. Place : Coimbatore Date :22.10.2019 Dr.T.ANITHA, Post Graduate Student, Department of Pathology, Coimbatore Medical College. CERTIFICATE I This to certify that the dissertation entitled “CYTOLOGIC SPECTRUM OF SALIVARY GLAND LESIONS WITH HISTOPATHOLOGICAL CORRELATION” is a record of bonafide work done by Dr. T.ANITHA, Post Graduate Student in the Department of Pathology, Coimbatore Medical College and Hospital, Coimbatore under the guidance and supervision of Dr.M.KAVITHA, M.D., Senior Assistant Professor, Department of Pathology, Coimbatore Medical College and Hospital, Coimbatore in partial fulfillment of the regulations of The Tamilnadu Dr.M.G.R Medical University, Chennai towards the award of degree of M.D.PATHOLOGY. Guide Dr. M.KAVITHA, M.D., Dr. A.DHANALAKSHMI, M.D., Senior Assistant Professor, Professor & Head, Department of Pathology, Department of Pathology, Coimbatore Medical College, Coimbatore Medical College, Coimbatore. Coimbatore . Dr. B.ASOKAN, M.S, M.Ch., Dean, Coimbatore Medical College, Coimbatore. CERTIFICATE –II This is to certify that this dissertation work titled “CYTOLOGIC SPECTRUM OF SALIVARY GLAND LESIONS WITH HISTOPATHOLOGICAL CORRELATION” of the candidate Dr.T.ANITHA with registration number 201713251 for the award of M.D degree in the branch of PATHOLOGY. I personally verified the urkund.com website for the purpose of plagiarism check I found that the uploaded thesis file contains from introduction to conclusion pages and result shows 7 (Seven) percentage of plagiarism in the dissertation. Guide and Supervisor sign with seal ACKNOWLEDGEMENT To begin with I thank the almighty God for bestowing his blessing on me in this dissertation a successful one. I wish to thank the dean Dr ASHOKAN, MS., Mch., Coimbatore Medical College and Hospital, for permitting me to conduct the study. It’s a great pleasure to express my humble gratitude to the most respectable teacher Dr .A. Dhanalakshmi MD., Professor and Head of the Department, Department of Pathology, Coimbatore Medical College, Coimbatore for her guidance and support. I express my gratitude and sincere thanks to my guide Dr.M.Kavitha M.D., Department of Pathology, Coimbatore Medical College, Coimbatore. I thank all Assistant Professors and Tutors of Department of Pathology, Coimbatore Medical College for their opinion and encouragement. I thank my parents, my children Srinidhi and Harshan, my friend Dr.Swathi for their extensive support. CONTENTS TABLE OF CONTENTS S.NO TITLE PAGE.NO 1 INTRODUCTION 1 2 AIM AND OBJECTIVES 4 3 REVIEW OF LITERATURE 5 4 MATERIALS AND METHODS 46 5 OBSERVATION AND RESULTS 49 6 DISCUSSION 71 7 SUMMARY 79 8 CONCLUSION 80 BIBLIOGRAPHY ANNEXURES MASTERCHART LIST OF TABLES S.NO TITLE PAGE.NO Age wise distribution of lesions of salivary 1 49 gland Gender wise distribution of lesions of salivary 2 51 gland Distribution of cases based on clinical 3 52 diagnosis Distribution of cases based on duration of 4 53 lesion 5 Distribution of cases based on size of lesion 55 6 Distribution of cases based on consistency 56 Distribution of cases based on location of 7 57 lesion Distribution of neoplastic tumors according to 8 58 histopathological diagnosis and location 9 Distribution of cases based on cellularity 59 10 Cytological diagnosis of salivary gland lesions 60 11 Cytological categorization of lesions 62 12 Histopathological diagnosis of lesion 63 13 Histopathological categorization of lesion 65 14 Cytohistopatholgical correlation 66 Diagnostic accuracy in benign neoplastic 15 67 lesions of salivary gland Diagnostic accuracy in malignant neoplastic 16 68 lesions of salivary gland Comparison of consistency –Benign Vs 17 69 Malignant Comparison of site of lesion-Benign Vs 18 70 Malignant Comparison of cellularity – Benign Vs 19 70 Malignant LIST OF CHARTS S.NO CHART PAGENO 1 Distribution of cases based on age 50 groups 2 Gender wise distribution of cases 51 3 Distribution of cases based on clinical 52 diagnosis 4 Distribution of case based on duration 54 of lesions 5 Distribution of cases based on size of 55 lesion 6 Distribution of cases based on 56 consistency 7 Distribution of cases based on location 57 of lesion 8 Distribution of cases based on 59 cellularity 9 Distribution of cases based on 61 Cytologic diagnosis 10 Distribution of cases based on 64 histopathological diagnosis ABBREVIATION FNAC - Fine needle aspiration cytology PA – Pleomorphic adenoma WT – Warthin’s tumor MEC – Mucoepidermoid Carcinoma CH SA – Chronic sialadenitis SD CA – Salivary duct carcinoma H &E – Hematoxylin and Eosin MGG – May GrunwaldGiemsa HPE –Histopathology Examination WHO - World Health Organisation INTRODUCTION INTRODUCTION Salivary glands are exocrine organs that secrete saliva widely distributed throughout the mouth and oropharynx. There are three pairs of salivary glands-parotid, submandibular and sublingual glands15. Minor salivary glands are about 800-100 located throughout the oral cavity in the buccal, labial lingual mucosa ,the soft palate ,lateral parts of hard palate and the floor of mouth. Salivary gland lesions form 2-5 percent of all Head and neck neoplasms4,6,8. Age incidence varies widely, extending from children to adults over 80 years of age. These glands are usually not subjected to incisional or core needle biopsy, because of the possible risk of fistula formation and tumor seedling18. Cysts and associated lesions with cystic changes are commonly encountered in Head and neck region. Pathology of these lesions are diverse and includes developmental, inflammatory, benign and malignant tumors which can be primary or metastatic. FNAC is a useful method for evaluating salivary gland lesions. It is of particular relevance in the head and neck area because of easy accessibility of the target site6 minimally invasive procedure, excellent patient compliance and thereby help to avoid surgery in non-neoplastic, inflammatory conditions. 1 It is a preferred method due to its low cost, rapid turnaround time, minimum morbidity. It has a high sensitivity and specificity for diagnosing neoplastic and non-neoplastic lesions It is useful to categorize the lesions into inflammatory, reactive, benign and malignant lesions and thereby useful for appropriate therapeutic management6,8,10. However, the heterogenecity of many salivary gland tumors along with overlap of cytomorphological features presents as a challenging work to conclude with precise diagnosis in some instances. The purpose of FNAC is not only to provide a definite specific diagnosis. But it is also used in conjunction with clinical and radiological findings to provide the best possible initial assessment from which management can be planned1,10. Till date, ultrasonography is acting as bridge between surgery and pathology.17 Pre-operative assessment of parotid swelling by cytology and ultrasonography is especially significant in our country where tuberculosis and metastatic squamous cell carcinoma invading perisalivary lymph nodes mimic parotid swelling. Major salivary gland neoplasms usually present with non-specific clinical symptoms ,requiring high degree of suspicion. FNAC offers an invaluable and accurate initial diagnostic tool for the management of these patients even in the era of the Immunohistochemistry. 2 The present study aims to correlate cytomorphological features of salivary gland lesions in FNAC and the corresponding histopathology in suspicious malignant cases. Keeping histopathological diagnosis as gold standard sensitivity, specificity and diagnostic accuracy of FNAC was calculated. An adequate and representative sampling is essential for proper cytological evaluation to reduce the errors in diagnosis. The diagnostic pitfalls in FNAC were evaluated along with practical suggestions to improve the diagnostic accuracy especially while dealing with mucinous lesions. Other varied reasons for diagnostic errors may be due to uncertainty of the site and tissues aspirated , minimal material and lack of architectural pattern in the smears as compared to histological sections. Relevant clinical data, radiological findings, along with cooperation between the clinician and cytopathologist10,13 are important in order to use FNAC to its best advantage. Thus the present study offers to examine the sensitivity, specificity and diagnostic accuracy of FNAC of salivary gland lesions with histopathological correlation and to identify the discrepancies contributing to pitfalls in diagnosis. 3 AIM & OBJECTIVES AIMS AND OBJECTIVES AIM: To analyse the diagnostic accuracy, sensitivity and specificity of FNAC in various salivary gland lesions and correlate with the histopathological findings. OBJECTIVES: 1. To analyse the clinical, Histological and cytological features of salivary gland
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