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LETTER TO EDITOR  
Year : 2011  |  Volume : 54  |  Issue : 2  |  Page : 424-425
Fine-needle aspiration biopsy of adenoid cystic carcinoma of the palatine tonsil


1 Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Iran
2 Department of Otolaryngology, Shiraz Medical School, Shiraz University of Medical Sciences, Iran

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Date of Web Publication27-May-2011
 

How to cite this article:
Azarpira N, Ashraf M J, Shishegar M. Fine-needle aspiration biopsy of adenoid cystic carcinoma of the palatine tonsil. Indian J Pathol Microbiol 2011;54:424-5

How to cite this URL:
Azarpira N, Ashraf M J, Shishegar M. Fine-needle aspiration biopsy of adenoid cystic carcinoma of the palatine tonsil. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Dec 16];54:424-5. Available from: http://www.ijpmonline.org/text.asp?2011/54/2/424/81613


Sir,

Minor salivary gland tumors are most commonly located in the oral cavity, particularly the hard palate, and less commonly in the paranasal sinuses, pharynx and larynx. [1] In contrast to major salivary gland tumors, which are mainly benign, tumors that arise from submucosal seromucinous minor salivary glands are more commonly malignant. The most common malignant minor salivary gland tumors are adenoid cystic carcinoma (ACC). [2] Because it grows very slowly, it is often diagnosed at a late stage. The combination of a delayed diagnosis and the tumor's propensity for early perineural and hematologic spread increases the risk of local recurrence and systemic metastasis. [2]

Here we describe the cytological features of ACC in the palatine tonsil. A 70-year-old man presented with a three-month history of a slowly growing mass in the right palatine tonsil. On examination of his throat, the tonsil was unusually large and contained a large ulcerative tender mass [Figure 1]. Fine-needle aspiration (FNA) showed cellular smears containing tissue fragments of cohesive, uniform cells that encircled hyaline-like material that was magenta color on Wright Giemsa [Figure 2]. The cytoplasm of the epithelial cells was scant and with slightly hyperchromatic round to oval nuclei. Mitotic figure was not found. These findings was in favor of ACC. [2],[3] Histologic examination of the tumor showed a classic ACC pattern, with solid sheets of medium-sized tumor cells demonstrating moderate nuclear pleomorphism and prominent nucleoli. The tumor cells surrounded multiple cystic spaces containing eosinophilic hyaline-like basement membrane material [Figure 3]. The surface epithelium of palatine tonsil show sloughing with surface ulceration.
Figure 1: Ulcerative large mass located in left palatine tonsil

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Figure 2: Sharply demarcated spherical structures surrounded by a layer of small slightly atypical cells. (Wright Giemsa staining; ×100)

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Figure 3: Solid and cribriform nests of basaloid cells lining cystic spaces filled with homogenous material (H&E; ×100)

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In the review of literature, ACC was reported as parapharyngeal mass. [4],[5] Another salivary gland tumors such as pleomorphic adenoma, malignant mixed tumor and polymorphous low-grade adenocarcinoma were also reported in this area. [6],[7],[8] Therefore, this is the first report of ACC in the palatine tonsil. Adenoid cystic carcinoma has non-specific symptoms and tends to grow quite slowly with a protracted clinical course. [7] The long-term prognosis of ACC depends on primary surgical treatment. The present case highlights the need for the clinician and pathologist to be aware of unusual lesions that may be found in the palatine tonsil.

 
   References Top

1.Ganly I, Patel SG, Coleman M, Ghossein R, Carlson D, Shah JP. Malignant minor salivary gland tumors of the larynx. Arch Otolaryngol Head Neck Surg 2006;132:767-70.  Back to cited text no. 1
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2.Klijanienko J, Vielh P. Fine-needle sampling of salivary gland lesions, III, Cytologic and histologic correlation of 75 cases of adenoid cystic carcinoma: Review and experience at the Institute Curie with emphasis on cytologic pitfalls. Diagn Cytopathol 1997;17:36-41.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Nagel H, Hotze HJ, Laskawi R, Chilla R, Droese M. Cytologic diagnosis of adenoid cystic carcinoma of salivary glands. Diagn Cytopathol 1999;20:358-66.  Back to cited text no. 3
    
4.Oliai BR, Sheth S, Burroughs FH, Ali SZ. "Parapharyngeal space" tumors: A cytopathological study of 24 cases on fine-needle aspiration. Diagn Cytopathol 2005;32:11-5.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Zhi K, Ren W, Zhou H, Wen Y, Zhang Y. Management of parapharyngeal-space tumors. J Oral Maxillofac Surg 2009;67:1239-44.  Back to cited text no. 5
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6.Hakeem AH, Hazarika B, Pradhan SA, Kannan R. Primary pleomorphic adenoma of minor salivary gland in the parapharyngeal space. World J Surg Oncol 2009;7:85.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Horky JK, Chaloupka JC, Putman CM, Roth TC, Weaver EM, Sasaki CT. True malignant mixed tumor (carcinosarcoma) of tonsillar minor salivary gland origin: Diagnostic imaging and endovascular therapeutic embolization. AJNR Am J Neuroradiol 1997;18:1944-8  Back to cited text no. 7
    
8.Pittman CB, Zitsch RP 3rd. Polymorphous low-grade adenocarcinoma of the tonsil: Report of a case and review of the literature. Am J Otolaryngol 2002;23:297-9.  Back to cited text no. 8
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Correspondence Address:
N Azarpira
Pathology Department, Nemazi Hospital, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.81613

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