Diagnostic challenges in aspiration cytology of the salivary glands

The main goal of fine-needle aspiration (FNA) of salivary gland lesions is to assist the clinician in the management of patients who present with a ma ss lesion, Cytologic examination aims to determine, if a process is inflamm atory and/or reactive, benign or malignant neoplasm and if possible renders a specific diagnosis. It has been argued that in the area of salivary glan d tumors, surgical management relies less heavily on a specific preoperativ e diagnosis, because almost all neoplastic salivary gland lesions will unde rgo surgical excision. However, knowing beforehand if a lesion is malignant or benign, will aid in planning surgery and may prompt or postpone decisio ns for surgical intervention. The salivary glands are unique in their histo logic complexity and morphological variability of tumors, which is reflecte d in the cytologic material. In addition to the overlapping morphologic pat terns of salivary gland tumors, they also represent relatively rare lesions , thus making it more difficult to acquire diagnostic expertise in FNA, Oth er than approaching salivary gland tumors by a description of single entiti es in their benign and malignant categories, we favor a more practical appr oach to diagnosis based on the key morphologic features noted in FNAs. This article addresses differential diagnoses according to the predominant cyto logic presentation with attention to the cell type and size, nature of the cytoplasm, and the smear background. Copyright (C) 2001 by W.B. Saunders Co mpany.