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Microscopic findings Aspiration showing high cellularity. Dirty background. n Mucinous? ? n Necrotic? ?

Salivary gland FNA Normal tissue? Present Matrix? Absent Clear cells? Oncocytic? Spindle cells? High

Differential diagnosis High grade mucoepidermoid carcinoma Salivary duct carcinoma Carcinoma ex PA Squamous cell

Carcinoma ex pleomorphic adenoma Cellular aspirate High-grade carcinoma, usually salivary duct carcinoma Metachromatic fibrillar

Salivary duct carcinoma Cellular aspirate Crowded 3 -dimensional groups of glandular cells Polygonal cells

High grade mucoepidermoid carcinoma Cellular aspirate Squamoid cells in crowded 3 -dimensional groups and

Diagnosis KCP 740 (C 10 -14717) n Parotid gland, fine needle aspiration; w High

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JT ONE!

Microscopic findings Aspiration showing high cellularity. Dirty background. n Mucinous? ? n Necrotic? ? Normal ductal or acinar cells are not identified. Cells are arranged in 3 -dimentional groups. Occasionally, cells with bare nuclei are identified. Cells have abundant cytoplasm with enlarged, pleomorphic and hyperchromatic nuclei. n Some the cells have relatively well-defined borders n Occasional cells are suspicious for having cytoplasmic mucin Some cells show central nucleolus. JT ONE!

Salivary gland FNA Normal tissue? Present Matrix? Absent Clear cells? Oncocytic? Spindle cells? High grade features? • High grade mucoepidermoid carcinoma • Salivary duct carcinoma • Carcinoma ex PA • Squamous cell carcinoma • Small cell carcinoma • Metastasis JT ONE!

Differential diagnosis High grade mucoepidermoid carcinoma Salivary duct carcinoma Carcinoma ex PA Squamous cell carcinoma Small cell carcinoma Metastasis JT ONE!

Carcinoma ex pleomorphic adenoma Cellular aspirate High-grade carcinoma, usually salivary duct carcinoma Metachromatic fibrillar matrix with embedded myoepithelial cells JT ONE!

JT ONE!

Salivary duct carcinoma Cellular aspirate Crowded 3 -dimensional groups of glandular cells Polygonal cells with abundant vacuolated or granular cytoplasm Enlarged, pleomorphic and hyperchromatic nuclei Prominent central nucleolus Background necrosis JT ONE!

High grade mucoepidermoid carcinoma Cellular aspirate Squamoid cells in crowded 3 -dimensional groups and sheets Well-defined borders Enlarged hyperchromatic nuclei with prominent nucleolus Occasional goblet cells containing intracellular mucin Mitotic activity JT ONE!

JT ONE!

Diagnosis KCP 740 (C 10 -14717) n Parotid gland, fine needle aspiration; w High grade malignant tumor, most likely high grade mucoepidermoid carcinoma. JT ONE!