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Q. My biopsy suggests that I have a parotid tumor. Should I be worried?

Answered by
Dr. Utkarsh Sharma
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on May 02, 2021

Hi doctor,

My biopsy report reads like this. Please comment.

Sections examined show a tumor composed of oncocytic cells arranged in cribriform, cystic, and papillary architecture. Comedonecrosis is present within the cysts. Most of the tumor in the biopsies is in situ. Immunohistochemistry was attempted for myoepithelial markers (p63, SMA) to look for invasive components. Most of the cribriform spaces are lined by myoepithelial cells. Block A2 focally has an area suspicious of invasion. This might be a sampling issue, and the biopsy may not be completely representative of the lesion.

#

Hi,

Welcome to icliniq.com.

I have read the description of the biopsy you have provided and will help you regarding it. I must emphasize that before commenting on anything, I must know the site (organ) of the biopsy performed that you have not mentioned. Similar descriptions may have different interpretations depending on the site or organ. So, please let me know the area of the biopsy. However, according to the description you provided, most of the biopsy material has in situ carcinoma (precursor of carcinoma), but suspicious focal areas are seen. I am hoping to hear back from you with more details. Take care.

Thanks for the reply, doctor,

The biopsy was performed in the right parotid gland.

#

Hi,

Welcome back to icliniq.com.

Salivary gland tumors (parotid is one of the salivary glands) include benign and malignant tumors.

Oncocytic cells appear in many lesions and cause diagnostic difficulties. To arrive at a definitive diagnosis, existing morphological and macroscopic findings should be evaluated altogether, and patterns of differential diagnosis should be formed, considering different types of cells and commonly seen patterns in the lesion. Besides, histochemical and immunohistochemical studies should be used for this purpose.

Salivary glands are composed of acini and ducts. Both of them contain epithelial cells. Epithelial cells are surrounded by myoepithelial cells in acini and by basal cells in ducts. Most neoplasia (tumor) originates from acinar or ductal epithelial cells and or myoepithelial or basal cells. When the tumor arises from epithelial cells, it is called in situ (restricted) until it breaches the outer myoepithelial or basal cell layer and spreads in the stroma (when it is called malignant).

The tumor seems to be confined by the myoepithelial cell layer in this biopsy, as evident by immunohistochemical markers SMA (smooth muscle actin) and p63 (tumor protein). However, a small focus is suspicious of the myoepithelial cell layer breach. Still, the pathologist is not convinced that the area is sufficient to comment on the breach as he feels the tissue submitted is not the complete representation of the actual tumor. Hence, fresh samples may be required for a more definitive opinion.

The ultrasonography findings and the gross (macroscopic details), if shared, could have further helped me in strengthening my opinion. I hope this helped, take care and all the best.

Thanks for the reply, doctor,

I have attached my CT and the notes from the first FNA biopsy and inconclusive FNA biopsy. I have only these reports other than the core biopsy that you have committed.

#

Hi,

Welcome back to icliniq.com.

I have thoroughly read all the attached reports (attachments removed to protect the patient's identity). The ultrasonography (shows infiltrative growth pattern and suspicious lymph nodes) and CT (computed tomography) scan findings are more suggestive of a malignant etiology. FNAC (fine-needle aspiration cytology) has more features of benign lesions than malignant, but FNAC alone has limited application here. When interpreted in correlation with radiological findings, FNAC and core biopsy are more towards a malignant etiology. As already mentioned, a definitive comment on benign or malignant etiology can be made only after the excision biopsy.

I hope you are in communication with the surgeon, who will plan the further plan of action. Take care, and I wish you all the best.


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