The smears are cellular and show numerous cohesive tissue fragments with intact cells and a few scattered naked nuclei. The tumor cells are large and have abundant cytoplasm that ranges from clear to coarsely granular. The nuclei are round and fairly regular in size. Some of the cells have prominent nucleoli. The background is vaguely granular.
The cytomorphologic features are consistent with acinic cell carcinoma. Acinic cell carcinoma cells often depict small uniform nuclei and can be confused with benign acinar tissue. The lack of a lobulated bunch of grapes-like appearance, the cellularity of the specimen, and the presence of naked nuclei and cellular debris suggest against benign tissue. The naked nuclei frequently seen associated with the tissue fragment can be mistaken for lymphocytes (leading to an incorrect diagnosis of Warthin tumor). Oncocytic neoplasms should also be considered, but the quality of the cytoplasm is more consistent with the zymogen granules of acinic cells than the finely granular cytoplasm typical of oncocytes.
References
1.Nagel H, Laskawi R, Buter JJ, Schroder M, Chilla R, Droese M. Cytologic diagnosis of acinic-cell carcinoma of salivary glands. Diagn Cytopathol. 1997;16(5):402412.
2.Stewart CJ, MacKenzie K, McGarry GW, Mowat A. Fine-needle aspiration cytology of salivary gland: a review of 341 cases. Diagn Cytopathol. 2000;22(3):139146.
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