Introduction
Salivary gland neoplasms account for less than 2% of all tumors in the human body.1 Among head and neck neoplasms in adults, salivary gland lesions comprise 2-6.5%.2
FNAC is now the most widely used and accepted tissue-based diagnostic procedure in salivary gland lesions before any surgery. 3 It becomes challenging at times due to overlapping of cytological features, so should be done in conjunction with history, clinical examination, radiological investigations, followed by histopathological examination. 4 It helps in differentiating neoplastic from non-neoplastic lesions and specific categorization,5 thereby avoiding unnecessary intervention.
The aim of this study was to evaluate the cytological spectrum of salivary gland lesions that presented to Gauhati Medical College and Hospital, Guwahati undergoing FNA during this 2-year period with respect to age, anatomical site, gender and type of lesion.
Materials and Methods
This is a 2-year retrospective study done in the cytology section of the department of Pathology, Gauhati Medical College and Hospital from January, 2019 to December, 2020. The study included 110 cases of salivary gland swellings of all age groups and both sexes.
The patient’s age, sex and anatomic location was recorded. FNAC was performed using 22-27 gauge 20 ml disposable syringe and the air dried, ethanol fixed smears are then stained using May Grunwald Giemsa (MGG) stain. The smears are then examined for adequacy, cellular arrangement, cell types, nuclear and cytoplasmic features. Depending on the cytological characteristics, these are grouped into three categories, non-neoplastic, benign and malignant.
Results
Gender wise, salivary gland lesions were more common in males (61.8%).
Table 1
Sex wise distributions of salivary gland lesions (n=110)
|
Sex |
No. of cases |
Percentage |
|
Male |
68 |
61.8 |
|
Female |
42 |
38.2 |
The most commonly involved age group was the fourth decade (28 cases), followed by the fifth.
Table 2
Age-wise distribution of salivary gland lesions (n=110)
|
Age group |
Total |
|
0-10 |
8 |
|
11-20 |
11 |
|
21-30 |
14 |
|
31-40 |
18 |
|
41-50 |
30 |
|
51-60 |
19 |
|
61-70 |
8 |
|
71-80 |
2 |
Among the total cases, most common location of salivary gland lesions was the Parotid gland.
Table 3
Anatomical distribution of adequate cases according to location and type (n=110)
|
Gland involved |
Number of cases |
|
Parotid gland |
78 |
|
Submandibular gland |
29 |
|
Minor salivary glands |
3 |
|
Total |
110 |
Among the total number of cases (110), 9 were non diagnostic. Most common type of lesion was benign neoplasm.
Table 4
Salivary gland lesions according to milan system
The most common type of lesion was benign, commonest being Pleomorphic adenoma (24.8%). Among the non-neoplastic lesions, sialadenitis (17.9%) was the most common. Mucoepidermoid carcinoma (10.9%) was the commonest of all malignancies reported in the salivary gland lesions of this study.
Table 5
Cytomorphological spectrum of salivary gland lesions (n=101)
Discussion
This is a 2-year retrospective study on 110 salivary gland lesions that underwent fine needle aspiration in the department of Pathology, Gauhati Medical College and Hospital, Guwahati during the period from January 2019 to December 2020. Analysis is being done with respect to adequacy for reporting, male to female ratio, commonest age group and gland affected and the type of lesion.
In this study, male to female ratio is 1.6:1, which is similar to that observed by studies done by Das DK et al6 (1.28:1), Omhare et al7 (1.17:1), Mayur et al8 (1.2:1), Malati et al9 (1.4:1), Swarna B. Patil et al10 (1.1:1), Singh et al5 (2.4:1) and Desai et al. 11
Most common age group affected was 41-50 years (28 cases, %). Similar results were observed by Swarna B Patil et al. 10 Studies done by Desai et al 11 and Mayur et al 8 showed the common age group affected as 31-40 years and 21-30 years respectively.
Location wise, parotid gland (72.3%) is the most commonly involved, which was in concordance with studies done by Mayur et al, 8 Roland NJ et al, 12 Singh et al, 5 Verma et al, 13 Sengupta et al, 14 Aruna et al 15 and Desai et al. 11
In this study, out of 110 cases, 109 cases (91.8%) were adequate for reporting. This was similar to studies done by Das et al6 (96% adequate aspirations), Nguansangiam et al 16(94.8%) and Sandhu et al 17(88.2%). The most common type of lesion was benign (37 cases, 36.63%), which is comparable with studies done by Sandhu et al 17 (66 cases, 82.5%), Nguansangiam et al 16 (89.47%) and Desai et al 11 (53.8%).
Among the non-neoplastic lesions, sialadenitis (17.9%) was the commonest. Studies done by Singh et al, 18 Ashraf et al 19 and Desai et al 11 had similar results.
Pleomorphic Adenoma was the commonest benign neoplasm, observed in 24.8% of total patients. Similar observations were made by Ito et al20 (67.8%), Sandhu et al17 (93.93%), Singh et al, 5 Khandekar MM et al and Desai et al. 11
Mucoepidermoid carcinoma (10.9%)was the most common malignancy in this study, which is similar to studies done by Jesus Souza et al, 21 Omhare et al,7 Mayur et al,8 Singh et al, 5 Chatterjee MT et al 22 and Desai et al. 11
Conclusion
Many studies done over the years have proved fine needle aspiration cytology as a very important, rapid, feasible, cost-effective and minimally invasive diagnostic procedure for salivary gland lesions. This also help in planning the management of such lesions along with avoidance of surgery in one-third of cases.23, 22 FNAC is now even preferred for various ancillary studies after cell block preparation from the obtained material.
