Fine Needle Aspiration of a Parotid Mass on 61-Year-Old Man

by Wells Chandler, MD, Pathology Resident, Department of Pathology, University of Utah.

Editor: Brian T. Collins, MD, Professor of Pathology, University of Utah, and Medical Director, Cytopathology, ARUP Laboratories

A sixty-one-year-old man presented to his primary care physician with an enlarged left parotid gland. The patient was referred to an otolaryngologist, who palpated a firm 2 cm nodule in the region of the left parotid gland. The patient was otherwise asymptomatic. A fine needle aspirate (FNA) was performed and smears and a cell block were prepared.

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FNA Findings

Fine needle aspiration shows the following:

  • The smears are cellular with many large 3-dimensional aggregates (fig. 1).
  • An extensive capillary network, providing a scaffold for the cellular clusters, is prominent at low power (fig. 2).
  • A "dirty" cyst fluid background visible at low power (fig. 1).
  • Cell debris, degenerating cells and lymphocytes are seen at higher power (fig. 3).
  • Crowded cell groups clinging to capillaries and forming papillary structures are frequent; however, salivary ducts are absent (fig. 4).
  • Ill formed acinar structures are present and may resemble normal salivary gland.(fig. 5).
  • The nuclei are medium sized, uniform and round with evenly dispersed chromatin and sometimes a small nucleolus (fig. 6).
  • Some areas on the smear show a mixture of abundant small round lymphocytes and epithelial elements (fig. 7).
  • The cell block sections are cellular and show a compressed acinar and papillary architecture. Clear cells are conspicuous in areas of the cell block (fig. 8).
  • A mucicarmine stain is negative (fig. 9).

Final Diagnosis & Discussion

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