A case of a 74-year-old male with unilateral nasal obstruction, recurrent epistaxis and a right intranasal mass is presented. It was initially diagnosed as hemangioma but final histopathology report revealed oncocytic carcinoma. Oncocytic carcinoma is a rare tumor of the salivary glands with very few reported cases, most of which involve the parotid gland. It has a tendency to recur with inadequate excision. Diagnosis is histopathologic. It is to be emphasized that adequate tissue samples should be taken in order to provide a definite diagnosis from biopsy, and subsequently institute proper definitive management.

Human ; Male ; Aged ; Parotid Gland ; Nasal Obstruction ; Epistaxis ; Salivary Glands ; Biopsy ; Hemangioma ; Neoplasm Recurrence, Local

Background: The Milan System for Reporting Salivary Gland Cytopathology (MSRGC) aims to increase the overall effectiveness of salivary gland FNAB by defining six general diagnostic categories with corresponding Rates of Malignancies (ROM). This study aims to use this system to categorize salivary gland FNAB in the Philippine General Hospital and stratify ROM per category. Methodology: In this study a total of 326 cases have been collected and reviewed, of which 154 (47.2%) had either surgical or clinical follow-up. The cases were assigned a Milan category by 3 cytopathologists blinded from the original diagnoses and from each other’s readings. Results: The overall sensitivity, specificity, PPV, and NPV in detecting neoplasm is at 71.6%, 90.9%, 88.3%, and 76.9%, respectively. On the other hand, the sensitivity, specificity, PPV, and NPV in detecting malignancy is at 52%, 92.9%, 59.1%, and 90.7%, respectively. The computed ROM is as follows: Category I 7.89%, Category II 9.43%, Category III 20%, Category IVa 10.53%, Category IVb 60%, Category V 75%, and Category VI 100%. Conclusion The overall diagnostic utility of salivary gland FNAB, as well as the computed ROM per diagnostic category are comparable to internationally published literature. This study also validates the MSRSGC as a valuable tool in stratifying ROM in salivary gland lesions.
Cytology ; Salivary Glands

A lateral neck mass can be the initial presentation of a papillary thyroid carcinoma. A 24-year-old female presented with a 2.0 x 2.0 cm, non-erythematous, non-tender, right lateral neck mass. A neck ultrasound showed an enlarged right jugulodigastric (Level II) lymph node and a normal-sized thyroid gland exhibiting mild parenchymal disease with no nodules. Positron emission tomography-computed tomography scan (PET-CT) showed an enlarged intensely fluorodeoxyglucose (FDG)-avid right level III lymph node, which may be primary versus metastatic. Fine-needle aspiration biopsy (FNAB) of the lymph node showed the presence of atypical cells that are highly suspicious for metastatic carcinoma. A cervical lymph node excision biopsy was performed and histopathology showed metastatic papillary thyroid carcinoma. The patient underwent total thyroidectomy with neck dissection. The final histopathologic examination of the thyroid gland revealed chronic lymphocytic thyroiditis with the lymph nodes negative for metastasis. She eventually underwent radioactive iodine ablation (RAI) with a dose of 30mCi. Post-RAI whole-body scan showed functioning thyroid tissue remnants with no distant metastasis. This case adds to the limited data that ectopic thyroid carcinoma can be present in patients who initially present with neck masses.
Thyroid Gland ; Carcinoma, Papillary

Objectives: To evaluate abnormal Papanicolau smear results at the Philippine General Hospital (PGH) for the past four years by comparing abnormal smear cytology with histologic interpretations. Possible causes of discrepant results were also determined.

Methods: All Pap smears released as abnormal from January 2014 to December 2017 and the corresponding available biopsies were retrieved. Discrepancy between cytologic and histology diagnosis was assessed and pairs with major discordance were reviewed.

Results: There were a total of 30,237 conventional pap smears signed out of which 239 (0.79%) were abnormal and only 56 (23%) had a subsequent tissue biopsy. The overall concordance rate is 75% while strict or absolute concordance rate is 32%. The overall discordance rate is 25%. Positive predictive value is highest for pap smears signed out as atypical glandular cells favor neoplastic (AGC-NEO) (100%), followed by malignant (93%), high grade squamous intraepithelial lesion (HSIL) (83%), and then atypical squamous cells cannot exclude an HSIL (ASC-H) and atypical squamous cell of undetermined significance (ASCUS), both at 67%.

Conclusions: Considering that the Philippine General Hospital is a referral and academic center, we have a low percentage of abnormal pap smears compared to other developing countries and even a lower percentage of patients who had subsequent biopsies. Cytohistologic correlation detected interpretative as well as sampling errors, and the aim is to work on these deficiencies by improving quality assurance protocols and modifying current local practices of both pathologists and clinicians.

Human