RESUMO
RESUMEN El cistoadenoma es un tumor epitelial benigno raro de glándulas salivales, de crecimiento lento y asintomático, que forma grandes masas uni o multiloculares con desarrollo papilar intraluminal. Si bien es más frecuente en glándulas salivales menores, se ha destacado lo inusual de la lesión en glándulas salivales mayores. Se presenta el caso de una mujer de 60 años, quien consultó por una masa indolora, blanda y de consistencia quistica en glándula parótida derecha, de crecimiento lento y progresivo. Su evolución fue de varios meses con piel de la zona intacta. Se realizó parotidectomia superficial. El examen histopatológico demostró cistoadenoma papilar oncocitico, tumor que ha sido destacado por su infrecuencia, y con una manifestación en parótida sumamente rara y de variados patrones histológicos. Su reconocimiento es trascendente para el profesional en casos como el que se presenta, pues su diagnóstico diferencial incluye lesiones con aspecto clínico similar y en algunos casos comportamiento agresivo.
ABSTRACT The cystadenoma is a rare benign epithelial tumor of salivary glands, characterized by slow growing and asymptomatic presentation, forming large uni or multilocular masses with intraluminal papillary development. Although it is more frequent in minor salivary glands, it has been emphasized the unusual of the major salivary glands affection. We present the case of a 60-year-old woman consulting for a painless, soft mass with cystic consistency in the right parotid gland, slow and progressive growing. The tumor evolved for several months keeping the skin of the area intact. A superficial parotidectomy was performed. Histopathological examination demonstrated a papillary oncocytic cystadenoma, a tumor that has been noted for its low frequency, and with extremely rare parotid manifestation and varied histological patterns. Its recognition is relevant for the professional in cases such as the one presented, since its differential diagnosis includes lesions with similar clinical appearance and in some cases aggressive behavior.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias Parotídeas/patologia , Cistadenoma Papilar/patologia , Adenoma Oxífilo/patologia , Glândula Parótida , Cistadenoma , Diagnóstico DiferencialRESUMO
Background Oncocytic (Hürthle) cell in fine-needle aspiration biopsy (FNAB) remains challenging for surgeons. Surgical treatment is recommended for oncocytic change in FNAB, since it can sometimes be a struggle to determine the nature of thyroid nodules. We aimed to investigate the clinical significance of oncocytic changes in FNAB in terms of management of patients. Methods The FNAB samples of 172 patients with thyroid nodules were reviewed. Of these, 39 patients with cytologic findings of oncocytic changes on FNAB [POC: predominance of oncocytic cells; SFON-H: suspicious for follicular or oncocytic neoplasm (Hürthle cell type), SM-O: suspicious for malignancy-papillary or follicular carcinoma; oncocytic variant)] were included. Results FNAB demonstrated POC in 14 (35.8%), SFON-H in 15 (38.4%), and SM-O in 10 (25.6%) patients. The overall malignancy rate was 35.8% (n = 14). Clinical and laboratory data were not found to be associated with thyroid cancer while nodule size was significantly higher in patients with thyroid malignancy (15.2 versus 23.3 mm, p = 0.032). Regarding FNAB results including oncocytic changes, the rate of malignancy was significantly different and almost three-fold higher in nodules classified as SFON-H and SM-O [48% versus 14.2% with POC, p = 0.044]. Besides, there was a positive correlation between SFON-H and SM-O cytology and malignancy (p = 0.036, r = 0.337). Conclusions It is hard to discern the significance of oncocytic changes in FNAB report and to determine an optimal approach as a surgeon. We recommend surgery for the patients with an FNAB showing SFON-H and SM-O whereas POC should be better to be followed-up.
