European Journal of Biomedical and Pharmaceutical Sciences

SALIVARY GLAND AMYLASE CRYSTALS: CYTOPATHOLOGICAL INSIGHT

Ayushi Bansal, Ajit Singh*, Hemlata Kamra, Ankit Mittal and Harvinder Singh

ABSTRACT

A 60 year old female presented to ENT OPD with a slightly painful swelling in left submandibular region since last 15-20 days. The patient also gave a brief history of swelling of whole left side cheek a week before the swelling developed with no history of weight loss, loss of appetite and fever. On examination the left submandibular swelling was about 3X2 cm in size, well circumscribed, tender, firm with slightly raised temperature of overlying skin and no skin changes. Patient was advised fine needle aspiration cytology. FNAC was done using a 22 gauge needle. A pus like aspirate admixed with blood was obtained. Smears were air dried, alcohol fixed and stained with Giemsa and papaniculaou. Ziehl Neelsen was also performed for acid fast bacilli to rule out tuberculosis. Multiple Giemsa stained smears were examined which showed dense admixture of inflammatory cells comprising of both acute and chronic inflammatory cells predominantly degenerated neutrophils, lymphomononuclear cells, clusters of histiocytes and multinucleated giant cells along with necrotic debris. Smears also showed numerous rectangular amylase crystals varying in size entrapped within these giant cells and macrophages as well lying singly (figure 1). Few cohesive clusters of reactive ductal cells were also seen. Background was dirty; showed necrosis and haemorrhage. ZN stain using 20% H2SO4 was non contributory. A few special stain along with polarizing microscopy was also done in view of abundant PAS stain showed positivity in amylase crystals (figure 2a). PAP stained smears showed abundant orangiophillic crystals (figure2b and 2c). Polarizing microscopy showed that these crystals were Non bifringent. No granuloma, atypia or malignancy was noted in the prepared smears. Patient follow up was done at 7th day and 14th day. The swelling had subsided to less than 1X1 cm and patient had no pain post treatment.

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