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Year : 2017  |  Volume : 60  |  Issue : 4  |  Page : 604-605
Salivary amylase crystalloids: An aspiration cytodiagnosis


Department of Pathology, Max Super Speciality Hospital, Saket, New Delhi, India

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Date of Web Publication12-Jan-2018
 

How to cite this article:
Arya A, Singaravel S, Kumar D, Das PS. Salivary amylase crystalloids: An aspiration cytodiagnosis. Indian J Pathol Microbiol 2017;60:604-5

How to cite this URL:
Arya A, Singaravel S, Kumar D, Das PS. Salivary amylase crystalloids: An aspiration cytodiagnosis. Indian J Pathol Microbiol [serial online] 2017 [cited 2019 Aug 25];60:604-5. Available from: http://www.ijpmonline.org/text.asp?2017/60/4/604/222969




A 78-year-old male with a slightly tender, firm swelling measuring 3 cm × 3 cm with indurated overlying skin in the left preauricular region presented to our department. The swelling was present for 1 month and had rapidly increased in size for the past 15 days leading to a clinical impression of malignant parotid neoplasm. Fine-needle aspiration was performed twice from different areas using a 22-gauge needle, and thick, gray-white, pus-like material was aspirated at both instances. Both air-dried May-Gruünwald-Giemsa (MGG)-stained and alcohol-fixed Papanicolaou (Pap)-stained smears were prepared.

Microscopic examination of the smears showed numerous rectangular-shaped crystalloids of varying sizes engulfed by multinucleate giant cells and also lying extracellularly. The crystalloids were deeply basophilic on MGG [Figure 1]a and translucent orange on Pap stain [Figure 1]b. Numerous neutrophils were seen in the background. No salivary gland components were seen. The crystals were nonbirefringent on polarization. Further investigations could not be carried out as the patient was lost to follow-up.
Figure 1: Large, rectangular salivary amylase crystalloids, basophilic in appearance on May-Grrge, r-Giemsa stain (a: MGG, ×400) and orangeophilic and translucent on Papanicolaou stain (b: Pap, ×1000) engulfed by multinucleate giant cells, lying in a suppurative background

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Salivary gland enlargement may be seen in both neoplastic and nonneoplastic diseases. Fine-needle aspiration is the preferred diagnostic modality, being both cost-effective and posing a minimal risk to the patient. Crystalline structures have been described in a variety of salivary gland lesions including cystic lesions,[1] sialolithiasis,[2] and in neoplastic conditions. The crystalloids may conglomerate to form the nuclei of calculi [2] or they may form crystalline granulomas.[3]

Salivary crystalloids can be of various types [4] such as amylase-rich, tyrosine, collagenous, oxalate, and intraluminal crystalloids. These specific types have characteristic shapes and specific associations with benign and malignant conditions.[5] Collagenous crystalloids are needle shaped, placed in a radial arrangement, and may be seen occasionally in pleomorphic adenomas. Tyrosine-rich crystalloids are petal shaped with blunt ends. They have been reported in pleomorphic adenomas as well as malignant neoplasms. Intraluminal crystalloids are geometrical in shape, composed of amorphous eosinophilic material and are associated with malignant neoplasms. Amylase-rich crystalloids, first reported by Takeda and Ishikawa in 1983,[1] are thought to represent crystallized amylase in supersaturated saliva. They are geometrical in shape but larger and glassier in appearance than intraluminal crystalloids. So far, amylase-rich crystalloids have been reported only in association with benign, cystic, nonneoplastic conditions.

In the present case, the crystalloids were morphologically consistent with amylase-rich type, being geometrical in shape, large in size, translucent in appearance, and nonbirefringent on polarization. Their presence evoked an acute inflammatory response with giant cell reaction resulting in sialomegaly. As the salivary gland is relatively resistant to bacterial infection, acute suppurative sialadenitis seen in this case may have been due to duct obstruction by sialolithiasis. Since our patient was elderly with a recent onset swelling which was rapidly increasing in size with indurated overlying skin, there was a strong clinical suspicion of a malignant neoplasm. The identification of amylase-rich crystalloids, a rare finding predominantly occurring in benign, cystic, nonneoplastic lesions on cytological evaluation was reassuring, excluding a malignant neoplasm in this elderly patient.

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   References Top

1.
Takeda Y, Ishikawa G. Crystalloids in salivary duct cysts of the human parotid gland. Scanning electron microscopical study with electron probe X-ray microanalysis. Virchows Arch A Pathol Anat Histopathol 1983;399:41-8.  Back to cited text no. 1
    
2.
Takeda Y. Crystalloids with calcareous deposition in the parotid gland: One of the possible causes of development of salivary calculi. J Oral Pathol 1986;15:459-61.  Back to cited text no. 2
    
3.
Takeda Y. Crystalloid granuloma of the parotid gland: A previously undescribed salivary gland lesion. J Oral Pathol Med 1991;20:234-6.  Back to cited text no. 3
    
4.
Nasuti JF, Gupta PK, Fleisher SR, LiVolsi VA. Nontyrosine crystalloids in salivary gland lesions: Report of seven cases with fine-needle aspiration cytology and follow-up surgical pathology. Diagn Cytopathol 2000;22:167-71.  Back to cited text no. 4
    
5.
Paker I, Anlar M, Genel N, Alper M. Amylase crystalloids on fine-needle aspiration of salivary gland. Turk J Pathol 2010;26:153-5.  Back to cited text no. 5
    

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Correspondence Address:
Saranya Singaravel
Institute of Laboratory Medicine, Max Super Speciality Hospital, Saket, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_306_16

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