Cytomorphological Spectrum of Head and Neck Lesions by Fine Needle Aspiration Cytology in a Tertiary Care Center

ABSTRACT

Introduction:

Fine needle aspiration cytology (FNAC) is considered the first line investigation of choice for evaluating head and neck swellings as it is a quick, safe, and rapid diagnostic procedure.

Material and Methods:

This is a retrospective study that included 242 cases of head and neck lesions in the Department of Pathology, Maharaja Agrasen Medical College, Agroha. FNAC was performed by aspiration and non aspiration techniques, and cytological diagnosis was given and correlated with clinical findings and investigations.

Results:

The most common age group affected was 21–30 years. Male to female ratio was 1:1.49. Out of 242 cases, maximum lesions were found in lymph nodes (128 cases), followed by thyroid gland in 81 cases, salivary gland in 23 cases, and miscellaneous group in 10 cases. Maximum number of cases reported were inflammatory (55.37%), followed by benign (29.33%) and malignant (11.15%) cases. Most swellings occurring in the head and neck region are inflammatory in nature.

Conclusion:

Our study concluded that FNAC is a simple, safe, and minimal invasive technique that differentiates between neoplastic and non neoplastic lesions and avoids unnecessary surgeries.

INTRODUCTION

Head and neck swellings are frequently seen in routine clinical practices by physicians. Patients with neck swellings are properly evaluated with a thorough history followed by complete head and neck examination, as the neck lesions are responsible for significant morbidity and mortality in India. Both benign and malignant lesions that are frequently encountered are cyst, goiter, tuberculosis, and other chronic inflammatory lesions and primary as well as metastatic lesions in cervical group of lymph nodes. In the last two decades, fine needle aspiration cytology (FNAC) has been considered as the first-line investigation of choice for evaluating head and neck swellings as it is a quick, safe, simple, cost-effective, and rapid diagnostic procedure.[1] FNAC is very helpful in differentiating inflammatory lesions from neoplastic lesions by causing minimal trauma to the patient.[2,3] The purpose of the present study was to study the cytological findings of head and neck swellings and to classify the nature of the swellings in a tertiary care center.

MATERIALS AND METHODS

This is a retrospective study carried out in the Department of Pathology, Maharaja Agrasen Medical College, Agroha. FNAC was performed in 242 patients who presented with swelling in the head and neck region. Proper detailed clinical history and thorough examination were done. This study was approved by the institutional ethical committee. All patients who presented with head and neck swelling were included in our study. Any patient with mass other than neck swelling was excluded from our study. Under all aseptic measures, FNAC was performed by using a 10-ml syringe with a 23- or 24-gauge needle. Both aspiration and nonaspiration techniques were performed. The aspirated material was placed on glass slides, and the slides were prepared and stained with Giemsa, hematoxylin and eosin (H&E), and Pap. Special stain used was Ziehl–Neelsen stain for acid-fast bacilli, wherever required.

RESULTS

Our study included 242 cases, of which the youngest patient was 1.5 years old and the oldest was 82 years of age. The mean age was 34 years. Male to female ratio was 1:1.49, and predominant affected age group was 21–30 years. Out of 242 cases, 128 cases (52.89%) were of lymph node, 81 cases (33.47%) were of thyroid gland, 23 cases (9.50%) were of salivary gland, and 10 cases (4.13%) were of miscellaneous groups.

Out of 242 cases of head and neck lesions, maximum number of cases reported were inflammatory (134 cases; 55.37%), followed by benign (71 cases, 29.33%) and malignant (27 cases, 11.15%) cases, and the remaining 10 cases (4.13%) were inadequate due to scant cellularity and hemorrhagic aspirate.

Lymph node lesions comprised 128 cases (52.89%) of all head and neck lesions. Out of these, the most common lesion was reactive (33 cases, 25.78%), followed by tubercular lymphadenitis (32 cases, 25%) and granulomatous (24 cases, 18.75%) lesions. The rest of the cases consisted of abscess (10 cases, 7.81%) and benign cystic lesion (three cases, 2.34%). In malignant lesions, metastasis from squamous cell carcinoma was the predominant finding (18 cases, 14.06%) followed by non-Hodgkin lymphoma (three cases, 2.34%) and one case (0.78%) of Hodgkin lymphoma; four cases (3.12%) were inadequate due to hemorrhagic aspirate.

A total of 81 cases of thyroid lesions were observed, in which the most common was colloid goiter (38.2%), followed by lymphocytic thyroiditis. Rest of the cases included colloid cyst, Hashimoto thyroiditis, adenomatous goiter, granulomatous thyroiditis and thyroglossal cyst.

Follicular neoplasm constituted (7.4 %), followed by papillary carcinoma and medullary carcinoma.

Totally 23 cases of salivary gland swelling were reported, out of which six cases (26.08%) were of chronic sialadenitis and two cases (8.69%) were of acute sialadenitis.

Benign neoplasm comprised eight cases (34.78%) of pleomorphic adenoma, two cases (8.69%) of Warthin’s tumor, and one case (4.34%) of oncocytoma, while one case (4.34%) of adenoid cystic carcinoma and three cases (13.04%) were inadequate in our study.

A total of 10 cases of miscellaneous lesions were observed, out of which five cases (50%) of epidermal inclusion cyst and four cases (40%) of lipoma and the remaining one case (10%) were inadequate.

As shown in Table 1, out of 134 cases of inflammatory swellings, the most common was lymph node (99 cases, 40.9%), followed by thyroid gland (22 cases, 9.09%) and eight cases (3.3%) of salivary gland and the remaining were five cases (2.06%) of miscellaneous. Among 71 cases of benign swelling, the most common was thyroid gland (53 cases, 21.9%), followed by 11 cases (4.54%) of salivary gland, four cases (1.65%) of miscellaneous, and three cases (1.23%) of lymph node. Out of 27 cases of malignant lesion, the maximum number belonged to lymph node (22 cases 9.09%), followed by four cases (1.65%) of thyroid gland and one case (0.41%) of salivary gland. No malignancy was observed among miscellaneous lesions.

Table 1.

Distribution of lesions according to the tissue involved and cytological diagnosis

Site of lesion	Cytological diagnosis
	Inflammatory		Benign		Malignant
	No. of cases	Percentage	No. of cases	Percentage	No. of cases	Percentage
Lymph node	99	40.9	3	1.23	22	9.09
Thyroid gland	22	9.09	53	21.9	4	1.65
Salivary gland	8	3.3	11	4.54	1	0.41
Miscellaneous	5	2.06	4	1.65	-	-
Total	134	55.35	71	29.3	27	11.1

DISCUSSION

In our study, lymph node lesions were predominant, followed by thyroid gland lesions. Similar observations were reported in other studies,[4-7] in which lymph node lesions were predominant. In our study, the predominant age group affected was 21–30 years. Similar findings were also observed by Gogoi and Borgohain[8] and Singal et al.[9] Our study shows female preponderance with a male: female ratio of 1:1.49, which was similar to other studies.[10,11]

In our study, the most common lymph node lesion was reactive lymphadenitis (25.78%), which shows correlation with other studies.[12,13] In our study, metastatic squamous cell carcinoma (14.06%) was the most common cause of malignancy in lymph nodes, as noted by Jadhav et al.[12] and Tandon and Gautam,[13] who reported 14.59% and 10.34% cases, respectively.

In the present study, the second most common site was thyroid in head and neck lesions. Among 81 cases, the most common lesions were benign in which colloid goiter was the most common followed by inflammatory lesions, which mainly constituted lymphocytic thyroiditis followed by follicular neoplasm. The other studies reported that most of the thyroid lesions were benign.[12,14,15]

In our study, the third most common site involved in head and neck lesion was salivary gland. Among inflammatory lesions, the most common was chronic sialadenitis (26.08%) followed by acute sialadenitis (8.69%), which shows correlation with Suryawansh et al.[15] The most common benign neoplasm was pleomorphic adenoma (34.78%), which shows correlation with Jadhav et al.[12]

CONCLUSION

In our study, most of the swelling occurring in the head and neck region was inflammatory. Colloid goiter was the most common benign lesion, whereas metastatic squamous cell carcinoma was the most commonly encountered malignancy. The present study concluded that FNAC is a simple and cost-effective diagnostic procedure that differentiates neoplastic and non-neoplastic lesions without any complications and avoids unnecessary surgeries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.