Journal of Cytology
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LETTER TO THE EDITOR Table of Contents   
Year : 2008  |  Volume : 25  |  Issue : 2  |  Page : 77-78
Amylase crystalloids in a cystic lesion of the parotid salivary gland diagnosed by fine needle aspiration cytology


1 Consultant Pathologist, Air Force Central Medical Establishment, New Delhi, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

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How to cite this article:
Singh G, Iyer VK. Amylase crystalloids in a cystic lesion of the parotid salivary gland diagnosed by fine needle aspiration cytology. J Cytol 2008;25:77-8

How to cite this URL:
Singh G, Iyer VK. Amylase crystalloids in a cystic lesion of the parotid salivary gland diagnosed by fine needle aspiration cytology. J Cytol [serial online] 2008 [cited 2020 Aug 8];25:77-8. Available from: http://www.jcytol.org/text.asp?2008/25/2/77/42459


To the Editor,

Cysts in the upper neck region yielding fluid on aspiration are frequently given nonspecific reports upon cytological examination. Noncellular structures may sometimes give a clue regarding their site of origin. We report here a case of a 65 year-old female patient previously diagnosed at the All India Institute of Medical Sciences, New Delhi, as having carcinoma of the tongue. While on radiotherapy, she was referred for fine needle aspiration (FNA) of a nodular swelling in the left parotid region, to rule out a recurrence. Clinical examination revealed a pea-sized, firm nodule measuring 0.8 x 0.8 cm from which a yellowish, clear fluid was aspirated. Smears were wet-fixed for Papanicolaou's (Pap) staining as well as air-dried for May-Grünwald Giemsa (MGG) staining.

The smears consisted mainly of necrotic debris admixed with numerous nonbirefringent crystalloids. These crystalloids stained bright orange by Pap stain with long parallel sides and pointed ends [Figure 1a]. Commonly they ranged from 80 to 120 microns in length and 15 to 25 microns in width. Smaller crystalline structures that were 20 to 80 microns in length and around 10 microns in width, being mainly rectangular in shape, were seen to be interspersed in the smears. Most of the crystals had concentric accretions giving them a paper clip-like appearance [Figure 1a]. MGG-stained smears showed deep blue staining of the crystalloids with frequent overstaining [Figure 1b]. Crystal microstructures within the crystalloids were less visible than with Pap staining and it was possible to overlook the structures as stain deposits. No evidence of carcinoma was found and neither inflammatory cells nor normal salivary gland tissues were identified. Occasional histiocytes were seen adhering to the crystalloids. A cytological diagnosis of a cystic parotid lesion with amylase crystalloids was made.

Jayaram et al . [1] first described such crystalline structures in FNA of benign cystic parotid glands in 1993. Johnson et al . [2] clearly established that these crystalloids represent crystallized alpha-amylase and are different from the tyrosine-rich crystalloids (sun-burst or petal-like structures with blunt ends), or collagen-rich crystalloids (radially arranged fibers of collagen around a clear central area) which are reported in pleomorhic adenomas. Intraluminal crystalloids (rods, rhombi, needles, and polyhedrons embedded in amorphous, eosinophilic material) seen in malignant salivary gland tumors are also different in appearance. [3] The present case exemplifies the characteristic morphology of amylase crystalloids, which helped in making a correct diagnosis of the lesion. As squamous cell carcinomas can undergo cystic change, the need for repeated aspirations and biopsies to rule out a carcinoma was eliminated. Awareness of cytopathologists regarding the nature of such crystalloids is essential for correct diagnosis of benign salivary gland cysts.

 
   References Top

1.Jayaram G, Khurana N, Basu S. Crystalloids in a cystic lesion of parotid salivary gland: Diagnosis by fine needle aspiration. Diagn Cytopathol 1993;9:70-1.  Back to cited text no. 1  [PUBMED]  
2.Johnson FB, Oertel YC, Ammann K. Sialadenitis with crystalloid formation: A report of six cases diagnosed by fine needle aspiration. Diagn Cytopathol 1995;12:76-80.   Back to cited text no. 2  [PUBMED]  
3.Ro JY, Mackay B, Batsakis JG, Cartwright J Jr. Intraluminal crystalloids in malignant salivary gland tumors (electron microscopy and X-ray microanalytic studies). J Laryngol Otol 1987;101:1175-81.  Back to cited text no. 3  [PUBMED]  

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Correspondence Address:
Venkateshwaran K Iyer
Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.42459

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  [Figure 1a], [Figure 1b]

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