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Cystic configurations of anaplastic squamous and mucoid cells
29%
114/394
Non-infiltrative clusters of epithelial and mesenchymal cells
11%
42/394
Epithelial cells with dense lymphoid stroma and germinal centers
35%
138/394
Large basophilic binucleate cells
15%
60/394
Uniform spindle cells with scant cytoplasm and cigar-shaped nuclei
8%
32/394
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The patient in this vignette presents with multiple painless firm masses arising from the parotid and submandibular glands with abnormal cranial nerve VII function. This presentation is suggestive of a malignant mucoepidermoid carcinoma which is characterized on histology by mucoid (muco) and squamous (epidermoid) cells. Mucoepidermoid carcinomas are the most common malignant tumors and most common radiation-induced tumors of the salivary glands. They typically affect the parotid gland and therefore may involve the facial nerve (CN VII) which passes through the parotid gland. In this patient, signs of cranial nerve palsy and multi-glandular involvement suggest that the underlying process is likely malignant. Histologically, mucoepidermoid carcinoma is often infiltrative with bland nuclei. Illustration A demonstrates the characteristic histologic appearance of mucoepidermoid carcinomas as seen on fine needle aspiration. Note the intermixed squamous and mucoid cells. Incorrect Answers: Answer 2: Pleomorphic adenoma is the most common benign salivary tumor and is characterized histologically by encapsulated clusters of epithelial and mesenchymal cells. Answer 3: Warthin’s tumor arises from lymphoid tissue in the salivary glands and is therefore composed of epithelial cells and lymphoid tissue. It is the second most common benign salivary tumor after pleomorphic adenoma and is frequently bilateral. Answer 4: Reed-Sternberg cells are large basophilic binucleate cells (owl’s eye appearance) that are pathognomonic for Hodgkin lymphoma. Despite the early history of Hodgkin lymphoma in this patient, the presentation of a mass at the angle of the jaw with cranial nerve involvement is more characteristic of a malignant salivary gland tumor. Answer 5: Schwannomas are tumors arising from Schwann cells. They are characterized histologically by uniform spindle cells with scant cytoplasm. Bullet Summary: Mucoepidermoid carcinomas are the most common malignant tumors of the salivary gland that are characterized by biphasic populations of mucoid and squamous cells.
2.8
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