Search Our Scientific Publications & Authors

Virchows Arch 2022 Jun 24. Epub 2022 Jun 24.

Department of Pathology, Jewish General Hospital, McGill University, 3755 Cote Ste Catherine Road, Montreal, QC, Canada.

The Milan system for reporting salivary gland cytopathology (MSRSGC) is a novel standardized classification tool for salivary gland cytology specimens based on the use of direct smears. Formalin-fixed paraffin-embedded (FFPE) cell blocks facilitate the use of ancillary studies, leading to improved diagnostic accuracy. However, the application of the MSRSGC with only cell blocks has not been well established. Read More

Semin Diagn Pathol 2022 Jun 15. Epub 2022 Jun 15.

Interventional Cytopathology, Precision Pathology, 7750 College Town Drive. Suite 102, Sacramento, CA 95826. Electronic address:

The second part focuses on my practice of USGFNA of lymph nodes, salivary glands, lesions of the head and neck, and breast masses. My experience with the handling and triage of various sorts of specimens, core needle biopsies, and cytology report timelines, with real-life anecdotes, is provided at the end. Read More

Semin Diagn Pathol 2022 Jun 14. Epub 2022 Jun 14.

University of Kentucky College of Medicine, Department of Pathology & Laboratory Medicine, Lexington, KY 40536, USA; University of Kentucky College of Medicine, Department of Urology, Lexington, KY 40536, USA; University of Kentucky, Markey Cancer Center, Lexington, KY 40536, USA. Electronic address:

Pathologist-performed fine-needle aspiration, or interventional cytopathology, is a minimally invasive, highly accurate technique for sampling and diagnosing palpable lesions. Utilizing cytomorphologic patterns during rapid onsite evaluation (ROSE) and final classification is one of many strategies that an interventional cytopathologist can employ to simplify the diagnostic approach. Herein, we provide an overview of the salient cytomorphologic patterns encountered in common specimens obtained by the interventional cytopathologist, including major salivary glands, the thyroid gland, and superficial lymph nodes. Read More

J Clin Exp Hepatol 2022 May-Jun;12(3):1012-1016. Epub 2021 Nov 16.

Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.

IgG4-related diseases are rare multisystem disorders involving salivary glands, retroperitoneum, pancreas, biliary tract, and liver. Isolated biliary strictures and gall bladder involvement are rare in such patients, and presentation with cholangitis and weight loss can misguide the diagnosis toward malignancy. Here, we report an interesting case of IgG4-related biliary stricture with gall bladder involvement, presented with cholangitis and weight loss. Read More

Case Rep Otolaryngol 2022 24;2022:8474741. Epub 2022 May 24.

College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.

Introduction: Acinic cell carcinoma (ACC) is a low-grade malignant salivary neoplasm that represents 17% of all salivary gland malignancies. It has a tendency to affect young individuals, especially females. ACC mainly originates in the parotid gland and has a potential for recurrence and metastases. Read More

Indian J Cancer 2022 Jan-Mar;59(1):123-127

Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India.

Langerhans cell sarcoma (LCS) is a rare malignant tumor of Langerhans cells and uncommonly involves head and neck regions. Unlike Langerhans cell histiocytosis (LCH), it has an aggressive clinical course with malignant cytological features. Till now, a handful of cases have been reported and the common anatomical sites involved are skin, lymph node, and bone in loco - regional cases and lymph node, lung, liver, spleen, and bone in disseminated disease. Read More

Int J Surg Pathol 2022 May 29:10668969221102552. Epub 2022 May 29.

Department of Pathology, 46657Gustave Roussy, Villejuif, France.

Mammary pleomorphic adenoma is a biphasic tumor, characterized by epithelial-myoepithelial components with myxochondroid stroma, resembling the prototypic pleomorphic adenoma of the salivary glands. We report the multiple diagnostic pitfalls raised by a mammary pleomorphic adenoma, initially diagnosed as mucinous carcinoma on fine-needle aspiration (FNA) cytology and invasive carcinoma on needle core biopsy. The final diagnosis was made on the surgical specimen. Read More

Diagn Cytopathol 2022 Jul 23;50(7):341-349. Epub 2022 Apr 23.

Department of Pathology, University of Utah Health Care and ARUP Laboratories, Salt Lake City, Utah, USA.

Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has been shown to have moderate to good reproducibility for categorization of salivary gland fine-needle aspiration (FNA) specimens. Less is known of its accuracy and interobserver reproducibility for categorization of the diagnostically difficult group of basaloid neoplasms.

Methods: Forty-five salivary gland specimens with a basaloid morphology (pleomorphic and monomorphic adenomas and adenoid cystic carcinomas) were independently assigned by seven cytopathologists to one of the MSRSGC categories. Read More

Ear Nose Throat J 2022 Apr 20:1455613221097200. Epub 2022 Apr 20.

Department of Otolaryngology-Head and Neck Surgery, 38051Asahikawa Medical University, Asahikawa, Japan.

Histiocytic sarcoma (HS) is an aggressive and rare hematological malignancy. Its treatment has not been established, and most patients die within 2 years of diagnosis. Resection can provide a favorable prognosis for solitary lesions. Read More

Head Neck 2022 06 7;44(6):1462-1467. Epub 2022 Apr 7.

Department of Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA.

Background: Milan system for reporting salivary gland cytopathology (MSRSGC) was introduced to standardize reporting of salivary gland cytopathology.

Methods: A retrospective review of ultrasound-guided fine needle biopsy of salivary gland lesions was performed between January 2018 and May 2021 at a community otolaryngology practice. Diagnostic accuracy and rate of diagnostic sialoadenectomy were calculated. Read More

Cytopathology 2022 Jul 25;33(4):463-471. Epub 2022 Apr 25.

Department of Pathology, SGR University, Dehradun, Uttarakhand, India.

Context: The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is a standardised six-tier reporting format aimed at ensuring better communication and improved patient management.

Aims: The main objectives of our study were to classify salivary gland fine needle aspirates into six categories of the MSRSGC and assess risk of malignancy (ROM), specificity, sensitivity, positive predictive value, and negative predictive value.

Settings And Design: This retrospective study covered a period of three years from January 2017 to December 2020. Read More

Surg Clin North Am 2022 Apr;102(2):325-333

Otolaryngology-Head and Neck Surgery, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195, USA. Electronic address:

Salivary cancers are rare tumors that arise in major and minor salivary glands. Workup almost always includes fine-needle aspiration or core needle biopsy in select cases. Imaging with ultrasound, computed tomography, or MRI is also helpful, particularly with MRI to assess facial nerve involvement or skull base involvement. Read More

Diagn Cytopathol 2022 Jun 14;50(6):295-299. Epub 2022 Mar 14.

Department of Pathology, GSVM Medical College, Kanpur, Uttar Pradesh, India.

Background: Interpretation of salivary gland cytology often leads to inter-observer variability due to heterogenous and complex nature of these lesions. This creates a dilemma regarding their management by clinicians. Proposal of a universal system of reporting of salivary gland lesions leading to agreement in diagnosis and better understanding among clinicians was the need of the hour. Read More

Autops Case Rep 2022 24;12:e2021357. Epub 2022 Feb 24.

North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Department of Radiology, Mawdiangdiang, Shillong, India.

Papillary cystadenocarcinoma of the salivary gland is a very rare malignant neoplasm accounting for only 2% of all salivary gland lesions. In 1991 it was first included as a separate entity in the World Health Organization (WHO) classification of salivary gland tumors and in 2017 WHO Classification, the tumor was clubbed as a sub-variant of adenocarcinoma, not otherwise specified. It most commonly occurs in the major salivary glands. Read More

Cancer Cytopathol 2022 Jun 4;130(6):423-432. Epub 2022 Mar 4.

Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois.

Background: With the development of new technologies and the changing patient profiles, cytopathology departments receive increasing numbers of adrenal gland cytology specimens. In this study, the authors analyzed archival adrenal gland cytology cases and attempted to implement a diagnostic reporting system.

Design: Retrospective electronic medical record search was performed for adrenal gland cytology specimens in seven tertiary care centers. Read More

Acta Cytol 2022 28;66(3):179-186. Epub 2022 Feb 28.

Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Objective: Fine-needle aspiration (FNA) biopsy is the standard diagnostic tool recommended by consensus management guidelines for preoperative evaluation of salivary gland tumors in adults. However, its utility in the pediatric population remains debated due to a paucity of data and inherited challenges of pediatric management (patient cooperation, the need for sedation, and procedural complications).

Methods: Consecutive series of 92 FNA biopsies of pediatric salivary gland lesions with available procedural data were included for retrospective analysis. Read More

Cancer Cytopathol 2022 Jun 23;130(6):443-454. Epub 2022 Feb 23.

Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio.

Background: Mesenchymal neoplasms of the parotid gland (PG) and para-pharyngeal (PP) space are distinctly uncommon. Fine-needle aspiration (FNA) biopsy experience with nonlipomatous neoplasms from this site is reviewed.

Methods: Cytopathology and surgical pathology files were examined for mesenchymal PG and PP space neoplasms. Read More

J Coll Physicians Surg Pak 2022 Mar;32(3):392-394

Department of Pathology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.

Primary malignant lymphomas of parotid gland are very rare. Most are B-cell lymphomas, and T-cell lymphomas are very rare. Unfortunately, fine needle aspiration biopsy is non-diagnostic. Read More

J Coll Physicians Surg Pak 2022 Feb;32(2):166-170

Department of Pathology, University of Health Sciences, Adana City Education and Research Hospital, Adana, Turkey.

Objective: To determine the effectiveness of Milan system for the evaluation of aspiration cytology to salivary gland lesions classification.

Study Design: Cross-sectional observational study.

Place And Duration Of Study: Department of Pathology, Tertier Centre, University of Health Sciences, Adana City Education and Research Hospital, Adana, Turkey from January 2014 to December 2020. Read More

Diagn Cytopathol 2022 May 31;50(5):265-269. Epub 2022 Jan 31.

Department of Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.

Pleomorphic adenoma of the salivary gland is a well-established and recognized diagnosis; however, pleomorphic adenomas of the breast are rare and can be difficult to diagnose on cytology or intraoperatively. We report a case that was misdiagnosed on a fine needle aspiration and frozen section. The pitfalls, differential diagnoses, and current management are discussed. Read More

Iran J Pathol 2022 20;17(1):97-103. Epub 2021 Aug 20.

Department of Pathology, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Acinic cell carcinoma (ACC) is a low or intermediate-grade malignant epithelial neoplasm of the salivary glands that generally shows an indolent behavior. Most cases arise in the major salivary glands, especially the parotid gland. ACC is usually known as a low-grade malignant tumor; however, poorly differentiated and high-grade transformed variants have been reported and may tend to be late recurrence and metastasis. Read More

Diagn Cytopathol 2022 May 29;50(5):235-252. Epub 2022 Jan 29.

Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Background: Ancillary studies are commonly performed on cell blocks prepared from fine-needle aspiration (FNA) specimens. There are limited studies in application of ancillary studies on cell blocks from salivary gland (SG) FNAs. This multi-institutional study evaluates the role of ancillary studies performed on cell blocks in the diagnosis of SG lesions, and their impact on clinical management. Read More

Cancer Cytopathol 2022 05 26;130(5):370-380. Epub 2022 Jan 26.

Department of Pathology, Catholic University of Sacred Heart University, Rome, Italy.

Background: Pediatric salivary gland fine-needle aspiration (FNA) is uncommon with a higher frequency of inflammatory lesions and a small proportion of malignancies. This international, multi-institutional cohort evaluated the application of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and the risk of malignancy (ROM) for each diagnostic category.

Methods: Pediatric (0- to 21-year-old) salivary gland FNA specimens from 22 international institutions of 7 countries, including the United States, England, Italy, Greece, Finland, Brazil, and France, were retrospectively assigned to an MSRSGC diagnostic category as follows: nondiagnostic, nonneoplastic, atypia of undetermined significance (AUS), benign neoplasm, salivary gland neoplasm of uncertain malignant potential (SUMP), suspicious for malignancy (SM), or malignant. Read More

Diagn Cytopathol 2022 Apr 5;50(4):154-161. Epub 2022 Jan 5.

Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

The term "Atypia" has been employed to describe a wide spectrum of cytomorphologic features associated with reactive/inflammatory processes as well as those suspicious for neoplasms in cytology. Similar to other cytopathology reporting systems, the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) has reserved the atypical category for cytology specimens lacking quantitative and/or qualitative cytomorphologic features to be diagnosed with confidence as either non-neoplastic or neoplastic. In MSRSGC, the atypical category is associated with a risk of malignancy and recommendation for clinical management. Read More

J Lab Physicians 2021 Dec 12;13(4):338-345. Epub 2021 Jul 12.

Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences, Shillong, Meghalaya, India.

Lymphocytic infiltrates of the major salivary glands are involved in a spectrum of diseases that range from reactive to benign and malignant neoplasms. Occasionally, these pathologic entities present difficulties in the clinical and pathological diagnosis. The aim of this study was to highlight the importance of meticulous cytopathological and histopathological examination (HPE) in solving the diagnostic challenges encountered in the analysis of these salivary gland lesions. Read More

Diagn Cytopathol 2022 May 29;50(5):E136-E139. Epub 2021 Dec 29.

Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania, USA.

A 15-year-old male presented to the hospital with a 2-month history of a right parotid mass. Magnetic resonance imaging revealed an encapsulated 3.7 cm mass. Read More

Cancer Radiother 2022 Feb-Apr;26(1-2):213-220. Epub 2021 Dec 22.

Département de radiothérapie, centre François-Baclesse, 3, avenue General-Harris, 14000 Caen, France; Normandie université, 14000 Caen, France; Réseau d'expertise français sur les cancers ORL rares (Refcor), 94800 Villejuif, France; Groupe d'oncologie radiothérapie des cancers de la tête et du cou (Gortec), 37000 Tours, France. Electronic address:

Primary tumours of the salivary glands account for about 5 to 10% of tumours of the head and neck. These tumours represent a multitude of situations and histologies, where surgery is the mainstay of treatment and radiotherapy is frequently needed for malignant tumours (in case of stage T3-T4, nodal involvement, extraparotid invasion, positive or close resection margins, histological high-grade tumour, lymphovascular or perineural invasion, bone involvement postoperatively, or unresectable tumours). The diagnosis relies on anatomic and functional MRI and ultrasound-guided fine-needle aspiration for the diagnostic of benign or malignant tumors. Read More

Diagn Cytopathol 2022 May 24;50(5):E123-E128. Epub 2021 Dec 24.

Pathology Laboratory, Hospital de Denia, Denia, Spain.

This report presents the clinical and pathologic findings of three cases of metastatic amelanotic melanoma to the parotid gland. Two of the patients had a primary cutaneous tumor. Fine-needle aspiration of the parotid showed clusters of epithelioid cells and/or spindle-shaped cells with vesicular nuclei, macronucleoli, and abundant eosinophilic cytoplasm. Read More

Am J Otolaryngol 2022 Mar-Apr;43(2):103296. Epub 2021 Dec 3.

Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, CA 94305, USA. Electronic address:

Purpose: Parotid gland incidentaloma (PGI) management has not been well characterized in the literature. This study assesses clinicopathologic features, initial evaluation, management, and outcomes of PGIs discovered on various imaging modalities.

Materials And Methods: This is a retrospective case series from a single academic institution. Read More

Cancer Cytopathol 2022 04 7;130(4):303-312. Epub 2021 Dec 7.

Department of Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico.

Background: Fine-needle aspiration (FNA) is the preferred diagnostic test for salivary gland lesions. The purpose of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) is to standardize salivary gland cytology reporting and guide treatment decisions. The objective of the current study was to evaluate the utility and performance of the MSRSGC, with a focus on the cytomorphology of lesions diagnosed as atypia of undetermined significance (AUS) and salivary gland neoplasm of uncertain malignant potential (SUMP). Read More