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FNA Quiz 1 This 50-year old white male smoker presented to the ORL Clinic with a left jaw mass of 4 months duration. He denies dysphagia, sore throat or voice changes. The followings are representative images. The most probable diagnosis is:
Answer: (A) Mucoepidermoid carcinoma.
Diagnostic Features in this case: There are solid sheets of cells in the FNA material (Panel C). Also present are cells with bubbly cytoplasm consistent with mucus secreting cells (Arrow in Panel B and high magnification in Panel E). The overall pleomorphism is not high. This is consistent with a low-grade mucoepidermoid carcinoma.
Discussion: Mucoepidermoid carcinoma represents less than 10% of all salivary tumors but in the parotid which in this patient it must be, mucoepidermoid carcinoma is far and away the most common primary malignant neoplasm. Three cell types can be recognized. Mucous cells or gland cells are rounded to columnar with vacuolated cytoplasm. Single glandular cells may resemble macrophages. Intermediate cells are small with a high N/C ratio. Squamous cells may be parabasal type or mature squamous cells.