\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:{caption:"IntechOpen Maintains",originalUrl:"/media/original/113"}},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
\n'}],latestNews:[{slug:"webinar-introduction-to-open-science-wednesday-18-may-1-pm-cest-20220518",title:"Webinar: Introduction to Open Science | Wednesday 18 May, 1 PM CEST"},{slug:"step-in-the-right-direction-intechopen-launches-a-portfolio-of-open-science-journals-20220414",title:"Step in the Right Direction: IntechOpen Launches a Portfolio of Open Science Journals"},{slug:"let-s-meet-at-london-book-fair-5-7-april-2022-olympia-london-20220321",title:"Let’s meet at London Book Fair, 5-7 April 2022, Olympia London"},{slug:"50-books-published-as-part-of-intechopen-and-knowledge-unlatched-ku-collaboration-20220316",title:"50 Books published as part of IntechOpen and Knowledge Unlatched (KU) Collaboration"},{slug:"intechopen-joins-the-united-nations-sustainable-development-goals-publishers-compact-20221702",title:"IntechOpen joins the United Nations Sustainable Development Goals Publishers Compact"},{slug:"intechopen-signs-exclusive-representation-agreement-with-lsr-libros-servicios-y-representaciones-s-a-de-c-v-20211123",title:"IntechOpen Signs Exclusive Representation Agreement with LSR Libros Servicios y Representaciones S.A. de C.V"},{slug:"intechopen-expands-partnership-with-research4life-20211110",title:"IntechOpen Expands Partnership with Research4Life"},{slug:"introducing-intechopen-book-series-a-new-publishing-format-for-oa-books-20210915",title:"Introducing IntechOpen Book Series - A New Publishing Format for OA Books"}]},book:{item:{type:"book",id:"7927",leadTitle:null,fullTitle:"Selected Topics in Child and Adolescent Mental Health",title:"Selected Topics in Child and Adolescent Mental Health",subtitle:null,reviewType:"peer-reviewed",abstract:"This book addresses a variety of critical themes that relate to child and adolescent mental health and working memory. It focuses on various theoretical perspectives as well as highlighting implications for practice. The topics contemplated include social media and mental health, parent-child interaction therapy (PCIT), the role of e-learning in mental health, perinatal depression and working memory, language, and reading and behaviour. In focusing on mental ill-health, this book addresses a global concern. The causes of poor mental health are complex and multi-faceted. In acknowledging this complexity, it must be recognized that there is no single ‘magic bullet’ that will solve the problem. A multidisciplinary approach is therefore required for approaching the issues, including a variety of interventions. Finally, the book emphasizes the important contributions that schools, health and social care services and families can provide about addressing the mental health challenges experienced by children and young people.",isbn:"978-1-78985-270-7",printIsbn:"978-1-78985-269-1",pdfIsbn:"978-1-83880-364-3",doi:"10.5772/intechopen.77757",price:100,priceEur:109,priceUsd:129,slug:"selected-topics-in-child-and-adolescent-mental-health",numberOfPages:82,isOpenForSubmission:!1,isInWos:null,isInBkci:!1,hash:"d0afa3f41927509c4a21502c591726b8",bookSignature:"Samuel Stones, Jonathan Glazzard and Maria Rosaria Muzio",publishedDate:"June 24th 2020",coverURL:"https://cdn.intechopen.com/books/images_new/7927.jpg",numberOfDownloads:5637,numberOfWosCitations:0,numberOfCrossrefCitations:3,numberOfCrossrefCitationsByBook:1,numberOfDimensionsCitations:5,numberOfDimensionsCitationsByBook:1,hasAltmetrics:1,numberOfTotalCitations:8,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"January 17th 2019",dateEndSecondStepPublish:"October 8th 2019",dateEndThirdStepPublish:"December 7th 2019",dateEndFourthStepPublish:"February 25th 2020",dateEndFifthStepPublish:"April 25th 2020",currentStepOfPublishingProcess:5,indexedIn:"1,2,3,4,5,6",editedByType:"Edited by",kuFlag:!1,featuredMarkup:null,editors:[{id:"309587",title:"Mr.",name:"Samuel",middleName:"Oliver James",surname:"Stones",slug:"samuel-stones",fullName:"Samuel Stones",profilePictureURL:"https://mts.intechopen.com/storage/users/309587/images/system/309587.jpg",biography:"Samuel Stones is a Lecturer and Researcher at Leeds Beckett University as well as Assistant Headteacher at a secondary school and sixth form located in North Yorkshire, England. He also holds a national training role with a large multi-academy trust. Samuel\\'s research outputs are linked with the Centre for LGBTQ+ Inclusion in Education and the Carnegie Centre of Excellence for Mental Health in Schools at Leeds Beckett University. His research explores the experiences of teachers who identify as Lesbian, Gay, Bisexual and Transgender, with specific emphasis on the impact of sexual orientation on teacher identity and mental health. Samuel\\'s research explores issues of social justice and inclusion, particularly in relation to mental health, special educational needs, sexual orientation and gender identity.",institutionString:"Leeds Beckett University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Leeds Beckett University",institutionURL:null,country:{name:"United Kingdom"}}}],equalEditorOne:null,equalEditorTwo:null,equalEditorThree:null,coeditorOne:{id:"294281",title:"Prof.",name:"Jonathan",middleName:null,surname:"Glazzard",slug:"jonathan-glazzard",fullName:"Jonathan Glazzard",profilePictureURL:"https://mts.intechopen.com/storage/users/294281/images/system/294281.png",biography:"Professor Jonathan Glazzard’s research focuses on mental health, well-being and inclusion in education. He is a qualitative researcher and uses a broad range of approaches, including narrative methodology, visual/participatory methods and more traditional interviews and focus groups. Jonathan’s recent projects include exploration of head teacher resilience, teacher and child mental health and the experiences of teachers who identify as LGBTQ+. Jonathan is a co-convenor of the British Educational Research Association (BERA) Special Interest Group, Mental Health and Wellbeing in Education. He is also a member of the Excellence in International Transitions Research, which is led by Professor Divya Jindal-Snape. Jonathan is deeply committed to research that advances social justice. He has widely published on aspects of inclusion and social justice for marginalised groups and individuals, and he is deeply committed to research that improves the lives of individuals and research-informed teaching.",institutionString:"Edge Hill University",position:null,outsideEditionCount:0,totalCites:0,totalAuthoredChapters:"2",totalChapterViews:"0",totalEditedBooks:"1",institution:{name:"Edge Hill University",institutionURL:null,country:{name:"United Kingdom"}}},coeditorTwo:{id:"286957",title:"Dr.",name:"Maria",middleName:null,surname:"Rosaria Muzio",slug:"maria-rosaria-muzio",fullName:"Maria Rosaria Muzio",profilePictureURL:"https://mts.intechopen.com/storage/users/286957/images/system/286957.jpg",biography:"Maria Rosaria Muzio, MD, works at the Division of Infantile Neuropsychiatry, UOMI - Maternal and Infant. Health, Asl Na 3 Sud, Torre del Greco, Naples, where she is responsible for Infantile Neuropsychiatry. Dr. Muzio graduated in Medicine and Surgery with honors, in 1997, at the Second University of Naples and then undertook postgraduate studies in in Child Neuropsychiatry, magna cum laude, gaining her doctorate in 2002. Currently, she is chief of the multidisciplinary team for the early diagnosis of neuropsychiatric disorders within the first 1000 days of life, Asl Na 3 Sud, Torre del Greco, Naples, Italy. Dr. Muzio acts as an editorial board member for several medical journals. 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At the same time, social media use can be beneficial and have positive effects. This chapter outlines the detrimental and positive effects of social media use for young people. Schools play a critical role in educating young people about how to use social media safely and responsibly. However, schools cannot address all the issues and parents, social media and advertising companies also have a responsibility to protect children and young people from harm. This chapter outlines some of the potential solutions to the issues that are identified.",signatures:"Jonathan Glazzard and Samuel Stones",downloadPdfUrl:"/chapter/pdf-download/68639",previewPdfUrl:"/chapter/pdf-preview/68639",authors:[{id:"309587",title:"Mr.",name:"Samuel",surname:"Stones",slug:"samuel-stones",fullName:"Samuel Stones"},{id:"294281",title:"Prof.",name:"Jonathan",surname:"Glazzard",slug:"jonathan-glazzard",fullName:"Jonathan Glazzard"}],corrections:null},{id:"71097",title:"Parent-Child Interaction Therapy: Theory and Research to Practice",doi:"10.5772/intechopen.91194",slug:"parent-child-interaction-therapy-theory-and-research-to-practice",totalDownloads:867,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"This chapter will focus on the theory behind and research on Parent-Child Interaction Therapy (PCIT), a treatment developed for young children with disruptive behavior problems. We will describe and provide details about PCIT, which is based on both attachment and social learning models, and incorporates an innovative approach to treatment in which therapists coach caregivers “live” via a wireless headset while each caregiver interacts with their child. In addition, we will review research that has examined PCIT with a variety of diverse populations (e.g., children with developmental delay, physical abuse histories, anxiety and depression, and children from underrepresented racial and ethnic minority families), settings (e.g., clinic, home, school) and formats (e.g., individual, group, intensive). Finally, we will present a case study of PCIT with a child younger than 2 years to demonstrate the effectiveness of PCIT and highlight some common challenges and pitfalls that clinicians may face in clinical practice.",signatures:"Perrine Heymann, Brynna H. Heflin and Daniel M. Bagner",downloadPdfUrl:"/chapter/pdf-download/71097",previewPdfUrl:"/chapter/pdf-preview/71097",authors:[{id:"313006",title:"Ph.D. Student",name:"Perrine",surname:"Heymann",slug:"perrine-heymann",fullName:"Perrine Heymann"},{id:"313007",title:"Dr.",name:"Daniel",surname:"Bagner",slug:"daniel-bagner",fullName:"Daniel Bagner"},{id:"313008",title:"MSc.",name:"Brynna",surname:"Heflin",slug:"brynna-heflin",fullName:"Brynna Heflin"}],corrections:null},{id:"68216",title:"Where Technology Meets Psychology: Improving Global Mental Health",doi:"10.5772/intechopen.88174",slug:"where-technology-meets-psychology-improving-global-mental-health",totalDownloads:801,totalCrossrefCites:1,totalDimensionsCites:1,hasAltmetrics:0,abstract:"Mental health disorders are a growing concern worldwide. Unfortunately, they are not limited to a single demographic group, and there are not enough mental health professionals to evaluate every case. Training other healthcare providers in mental health topics is a possibility; nevertheless, relying on face-to-face training alone is not scalable. The use of technology has become an essential and feasible opportunity to address global education challenges. Furthermore, the use of e-learning could be an important strategy to reach effective mental health care and address disparities worldwide. This paper describes the importance of e-learning and e-MH (e-mental health) leaning for health providers and the possibility of e-learning as a solution to strengthen human resources for mental health globally. The use of e-MH learning creates an opportunity to overcome social, geographical, economic, and educational barriers and to train worldwide health professionals in mental health.",signatures:"Martha Escobar Lux and Juan Manuel Escobar",downloadPdfUrl:"/chapter/pdf-download/68216",previewPdfUrl:"/chapter/pdf-preview/68216",authors:[{id:"295474",title:"Dr.",name:"Martha",surname:"Escobar Lux",slug:"martha-escobar-lux",fullName:"Martha Escobar Lux"}],corrections:null},{id:"72282",title:"Pregnancy in Adolescence: A Hallmark of Forthcoming Perinatal Depression?",doi:"10.5772/intechopen.92644",slug:"pregnancy-in-adolescence-a-hallmark-of-forthcoming-perinatal-depression-",totalDownloads:702,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"Over the last decades, teenage sexual behavior has come to expand toward unknown grounds mostly under the constant change in sociopolitical and cultural background. Whether they culminate in unintended pregnancies or not, adolescent reproductive health issues reside basically in the lack of proper implementation of educational programs and/or difficulty in accessing contraceptive methods. Until now, retrospective studies succeeded to identify a few characteristics correlated with adolescent pregnancies and their outcomes, while in low-income countries, socioeconomical disadvantages play a significant role in the lives of pregnant teenagers, and mental health affections such as depression and anxiety as well as noxious behavior are typically the appanage of high-income countries. By establishing cultural- and geographical-related peculiarities of young patients with impact on their pregnancy, raising awareness toward the spread of this new trend in obstetrical medicine might prove to be effective in practice when counseling these patients.",signatures:"Alexandra Matei and Cringu Antoniu Ionescu",downloadPdfUrl:"/chapter/pdf-download/72282",previewPdfUrl:"/chapter/pdf-preview/72282",authors:[{id:"215200",title:"Prof.",name:"Cringu Antoniu",surname:"Ionescu",slug:"cringu-antoniu-ionescu",fullName:"Cringu Antoniu Ionescu"},{id:"314326",title:"Dr.",name:"Alexandra",surname:"Matei",slug:"alexandra-matei",fullName:"Alexandra Matei"}],corrections:null},{id:"69218",title:"Working Memory, Language, Reading and Behavior: The Importance of Laterality, Symbolism and Default Networks",doi:"10.5772/intechopen.88175",slug:"working-memory-language-reading-and-behavior-the-importance-of-laterality-symbolism-and-default-netw",totalDownloads:696,totalCrossrefCites:0,totalDimensionsCites:0,hasAltmetrics:0,abstract:"The present review draws attention to the importance of working memory, not just for cognitive development, but also for language-related reading skills. 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Fine needle aspiration cytology (FNAC) is an important diagnostic tool for initial evaluation of salivary gland (SG) tumours. The global annual incidence for all SG tumours varies from 0.4 to 13.5 cases per 100,000 population [1]. Tumours of intraoral salivary glands (SGs) are relatively uncommon as compared to tumours of major SGs and constitutes 10–15% of all SG tumours with relative frequency varying from 0.4% to 1.52% in different part of the world [2, 3]. These tumours have a very distinct profile from tumours of major SGs with reference to tumour histological type, clinical presentation and distribution. Majority of intraoral minor SG tumours are malignant in contrast to major SG tumours where benign tumours outnumber the malignant ones [4]. While some studies documents mucoepidermoid carcinoma (MEC) as the most common malignant tumour of minor SGs, other studies documents adenoid cystic carcinoma (ADCC) or pleomorphic adenoma (PA) as the most common tumour [5, 6, 7, 8, 9, 10]. This difference in frequency of these histological types may be attributed to the differences in geographic location, race and varied clinical presentation. The clinical presentation of intraoral SG tumours also range from mild pain to visible palpable mass in the oral cavity with or without ulceration leading to obstructive features such as difficulty in swallowing and deglutition. These tumours can occur at various intraoral locations such as mucosa of lips and cheeks, hard and soft palate, uvula, floor of the mouth, tongue, retromolar area and peritonsillar region. The hard palate is the most common site of occurrence [3, 4, 5]. Cytopathological evaluation of intraoral SG tumours is challenging as these tumours show heterogeneity and considerable morphological diversity and overlap [6]. The correct preoperative cytopathological diagnosis of intraoral SG tumours is essential for deciding further course of management and treatment. We here present key cytomorphological features of intraoral salivary gland tumours and tumour-like lesions with emphasis to overcome diagnostic challenges and pitfalls.
FNAC is easy, minimally invasive, cost effective technique which provides a rapid initial preoperative diagnosis of SG tumours and has an impact on subsequent management and treatment [11]. The sensitivity and specificity of FNAC in diagnosing SG tumours is 85–100% and 90–100% respectively. The aspirated material obtained through FNAC can also be utilized for special staining such as Periodic acid-Schiff (PAS), Periodic acid-Schiff with diastase (PAS-D), Mucicarmine, Phosphotungstic acid-haematoxylin (PTAH), Acid fast bacilli (AFB) and Gram staining for further evaluation and diagnosis. PAS-D and mucicarmine are particularly useful for highlighting mucin containing cells in challenging cases of low-grade mucoepidermoid carcinoma (MEC). Similarly, PTAH stain can be applied on paraffin-embedded cell block preparation for identification oncocytic cells in challenging diagnosis of tumours with oncocytic differentiation. The cell blocks can also be utilized for Immunohistochemistry (IHC) for demonstrating epithelial and myoepithelial components in diagnosis of challenging tumours. The epithelial cells are positive for immunohistochemical markers such as cytokeratin and epithelial membrane antigen (EMA) and the myoepithelial cells show positivity for smooth muscle actin (SMA), calponin, p63 and S-100. Further, the aspirated material can also be used for microbiological culture, immunophenotyping and molecular analysis for confirming the cytological diagnosis. While the FNAC of palpable lesions in major SGs is relatively easy, the FNAC of intraoral SGs is challenging as many times aspirates are not cellular as these intraoral sites are often difficult to approach and sometimes inaccessible [10, 11, 12]. In such cases, radiological-guided FNAC may be advised for better yield of aspirates for subsequent cytological diagnosis. Also, while performing FNAC, there are chances of complications such as hemorrhage, nerve pain and damage and infection. There can be post FNAC induced changes in tissue such as squamous metaplastic changes, inflammation, granulation tissue formation and sometimes infarction, which may interfere with subsequent histological diagnosis. Therefore, familiarity with key cytological features with recognition of the subtle cytomorphological changes in cells is crucial for overcoming barriers and making a correct diagnosis.
The Milan system for reporting salivary gland cytopathology (MSRSGC) is an evidence based international classification and was developed by international consortium with the aim to standardize reporting terminology for categorizing SG lesions [13]. The intraoral SG tumour and tumour-like lesions can also be categorized according to MSRSGC. The system has advantage and impact on clinical management of the patients [13, 14]. The system consists of following six broad diagnostic categories.
It includes FNAC smears with insufficient cellular material for making a definite diagnosis.
Includes FNAC smears with benign non-neoplastic lesions such as sialadenitis, sialolithiasis, granulomatous inflammation etc.
FNAC smears with limited cellular atypia that lacks qualitative or quantitative features of a neoplasm. Smears showing reactive or reparative atypia and metaplastic changes are included in this category.
This category is classified into:
FNAC specimens that have some but not all the criteria for a specific diagnosis of malignancy and yet the overall cytologic features are sugsgestive of malignancy.
FNAC specimens that are diagnostic of malignancy. The tumours of intraoral SGs with frank features of malignancy are included in this category.
In this chapter, the intraoral SG tumours and tumour-like lesions are being discussed under following six headings for better understanding of these tumours and related diagnostic challenges and pitfalls.
The matrix producing tumours of intraoral SGs are pleomorphic adenoma (PA), adenoid cystic carcinoma (ADCC), polymorphous adenocarcinoma (POA). Carcinoma ex pleomorphic adenoma (CEPA), epithelial-myoepithelial carcinoma (EMC) are other matrix producing tumours that can also occur in intraoral SGs.
Pleomorphic adenoma is the most common benign tumour of SGs. Although, majority of PA occur in parotid gland, some studies documents PA as most common neoplasm in intraoral minor SGs [2, 4]. In the oral cavity, it usually presents as a solitary nodule or mass in the palate, sometimes with obstructive clinical symptoms.
1a: FNAC smear showing abundant chondromyxoid matrix with embedded cells in a case of pleomorphic adenoma (May-Grunwald Giemsa stain x 40), 1b: Corresponding histopathology showing nests, interlacing cords and strands of epithelial and myoepithelial cells in a myxoid stroma (Haematoxylin & Eosin x 40).
Sometimes, aspirate from PA may consist of only chondromyxoid substance without presence of epithelial and myoepithelial cells. The diagnosis of a neoplasm can be suspected but reaspiration is needed to rule out the possibility of other matrix producing tumours such as adenoid cystic carcinoma (ADCC) which can also occur at various intraoral locations. Both of these tumours have fibrillar metachromatic matrix and may show formation of hyaline globules. However, the matrix in PA is fibrillar with frayed edges (Figure 2a) while in ADCC the matrix is in form of beaded finger-like fragments, acellular spheres and tubules with sharply defined edges (Figure 2b) [15, 16]. Cellular PA with scant matrix particularly may resemble solid variant of ADCC. The cells of ADCC are basaloid and careful examination of nuclear chromatin of cells reveals distinguishing features. The cells in PA have bland finely granular chromatin while the cells of ADCC have coarse nuclear chromatin, high nuclear-cytoplasmic (N:C) ratio, scant cytoplasm and nucleoli [15]. The cells of ADCC may show focal nuclear moulding. Stripped naked nuclei can be seen in ADCC but not in PA. However, in challenging cases, it is not always possible to distinguish between the two entities. Such cases may be placed in SUMP category (IVB) of the Milan system. Follow-up and excision may be advised keeping clinical context in mind.
Cells in PA may undergo cystic and metaplastic changes. The aspirate may consist of metaplastic squamous cells with or without keratinisation (Figure 3) and scant or absent fibrillar metrachromatic matrix which can raise suspicion of a low-grade mucoepidermoid carcinoma (MEC) [16]. The intermediate cells of MEC in particular resemble squamous metaplastic cells of PA. However, the MEC usually have a dirty background and lacks myoepithelial cells, chondromyxoid material and keratinisation. One should also search for mucus cells, if MEC is suspected. In challenging cases, mucin containing cells of MEC can be demonstrated by using PAS-D or mucicarmine staining on cell blocks.
The myoepithelial cells in PA may sometimes show reactive atypia and prominent anisokaryosis which may sometimes be difficult to distinguish from malignant tumours [17]. Cells with reactive atypia can be recognized as they have bland chromatin and inconspicuous mitotic activity. The diagnostic pitfall is the occurrence of carcinoma ex-pleomorphic adenoma (CEPA). The development of CEPA in pre-existing intraoral PA is rare but few cases have been reported in literature [18]. History of long standing or recurrent PA in oral cavity with recent sudden increase in size along with cytological evidence of high grade atypical features in cells (Figure 4) and even a focal presence of areas depicting conventional PA consisting of benign cell clusters and chondromyxoid matrix (Figure 4), should lead to the diagnosis of CEPA [18, 19].
Epithelial-myoepithelial carcinoma (EMC) may sometimes also simulate a PA. It is a an unusual tumour and can also occur in minor SGs and palate [20]. This tumour can also have hyaline globules and show thin basement membrane-like metachromatic material around the clusters of cells. The predominant cell of EMC is myoepithelial. These cells are larger with abundant fragile clear delicate cytoplasm. Unlike PA, naked or stripped nuclei can be seen. Moreover, the biphasic population of epithelial and myoepithelial cells can be identified in EMC. The key cytological features and pitfalls of EMC are discussed at 4.3.1.
PA with predominant myoepithelial component (Figure 5a) may resemble other myoepithelial cell containing tumours such as myoepithelioma/myoepithelial adenoma (Figure 5b) in oral cavity. Myoepithelioma lacks chondroid stroma and duct cells seen of PA [21]. Distinction may not always be possible and is not of much significance as both entities are benign (Milan system category IVA) and management is almost similar.
2a: Smear showing abundant fibrillar metachromatic matrix with frayed edges in pleomorphic adenoma (May-Grunwald Giemsa stain x 40), 2b: Showing metachromatic matrix in form of acellular beaded, finger-like fragments and hyaline spherical globules with well-defined borders in a case of adenoid cystic carcinoma (May-Grunwald Giemsa stain x 40).
3a: FNAC smear showing pleomorphic adenoma with squamous metaplasia (arrows) (May-Grunwald Giemsa stain x 4), 3b: Corresponding histology showing squamous metaplasia with evidence of keratinisation (arrow) surrounded by myxoid stroma (Haematoxylin & Eosin x 40).
4a: Showing malignant cells with high N:C ratio and hyperchromatic nuclei (black arrows) in a case of carcinoma ex-pleomorphic adenoma with evidence of metachromatic matrix of pre-existing pleomorphic adenoma (white arrow) (May-Grunwald Giemsa stain x 40), 4b: Corresponding histology showing sheet of malignant cells (white arrow) arising in background of myxoid stroma (black arrow) of pleomorphic adenoma (Haematoxylin & Eosin x 10).
5a: FNAC smear showing population of myoepithelial cells (black arrow) with metachromatic matrix (white arrow) in a case of myoepithelial predominant pleomorphic adenoma (May-Grunwald Giemsa stain x 40). 5b: Smear showing myoepithelial cells with pale to clear cytoplasm (arrow) in a case of a myoepithelioma (May-Grunwald Giemsa stain x 40).
It constitutes nearly 10% of all SG tumours. Some studies suggest it to be the most common malignancy in minor salivary gland with hard palate being the most common site [22, 23, 24].
6a: Smear showing large hyaline spherical globules with well-defined borders with attached tumour cells in cup-shaped fashion (arrow) and also scattered singly in a case of adenoid cystic carcinoma (Papanicolaou stain x 4). 6b: Corresponding histological section showing tumour cells surrounded by basement membrane-like metachromatic material (PAS x 40).
PA and its distinguishing features from ADCC are discussed at 4.1.1a. However, the diagnosis of solid variant of ADCC is challenging as it lacks metachromatic matrix [25]. It can be distinguished from PA as it shows three dimensional clusters of basaloid cells with variable degree of pleomorphism. The cells are more hyperchromatic and angulated than in PA. In contrast to PA, mitosis, apoptosis and necrosis can also be seen [25]. IHC on cell blocks with CD -117 can be done in challenging cases which shows strong cytoplasmic positivity in ADCC [25, 26].
Sometimes, the basement membrane-like metachromatic material in EMC forms large globules resembling ADCC but the cellular compartment is entirely different in ADCC [26]. The cells of ADCC are basaloid with scant cytoplasm with round to ovoid hyperchromatic nuclei with coarse nuclear chromatin and nucleoli in contrast to myoepithelial cells of EMC with clear cytoplasm and round nuclei and vesicular chromatin [26].
Basal Cell Adenoma (BCA) can resemble ADCC. However, BCA arise predominantly in parotid and is extremely rare in the intraoral minor SGs [27]. It also shows metachromatic matrix and basement membrane like material and basaloid cells similar to ADCC but cells have granular chromatin rather than coarse nuclear chromatin seen in ADCC. The cells occasionally show peripheral palisading. Squamous morules or metaplasia can be frequently seen in BCA but not in ADCC.
Canalicular (CA) /Ductal Adenoma occurs in oral cavity predominantly in upper lip and buccal region [28]. It has overlapping cytological features with BCA. Cells of CA are cuboidal to columnar and are seen in clusters and cords. Unlike ADCC, the cells are monomorphic with finely dispersed chromatin and inconspicuous nucleoli.
Previously called as polymorphous low grade adenocarcinoma, it is a low-grade matrix containing tumour occurring predominantly in intraoral minor salivary gland with palate being the most common site [29].
7a: Smear showing monomorphic small round to oval epithelial cells attached to fibrous stromal core in a case of polymorphous adenocarcinoma (Papanicolaou stain x 40), 7b: Corresponding histology showing growth of tumour cells in glandular and acinar pattern (black arrows) surrounded by adjacent fibrous stroma (white arrows) (Haematoxylin & Eosin x 10).
The cytological features of POA may resemble PA or ADCC [30]. The matrix of POA may be fibrillar and myxoid resembling a PA or can form hyaline globules similar to ADCC. However, the papillary architecture of cells is found in POA and its presence can distinguish it from PA and ADCC. The cells of ADCC are basaloid with coarse nuclear features rather than fine open nuclear features seen in POA [30].
Cystic tumours of intraoral SGs range from benign tumours such as sclerosing polycystic adenosis, cystadenoma, cystic PA, duct papilloma to malignant tumours such as low-grade MEC and papillary cystic variant of acinic cell carcinoma (AciCC). Evaluation and interpretation of these cystic tumours is particularly challenging as usually the aspirate of these tumours is hypocellular. This may result in false negative diagnosis particularly in a low-grade malignant cystic tumours.
8a: Showing small sheets and clusters of epidermoid cells in a cystic mucoid background in a case of low-grade mucoepidermoid carcinoma (Papanicolaou stain x 10), 8b: Corresponding histology showing sheets of epidermoid cells (Haematoxylin & Eosin x 10).
9a: Showing cells arranged in a predominant papillary architecture with fine fibrovascular core in a case of acinic cell carcinoma. The cells have fine vacuolated cytoplasm (May-Grunwald Giemsa stain x 4), 9b: Corresponding histology showing branching papillae (arrow) with fibrovascular core (Haematoxylin & Eosin x 4).
The differential diagnosis of tumours of intraoral SGs comprising of clear cells and vacuolated cell pattern include – Epithelial–Myoepithelial carcinoma (EMC), Myoepithelial tumours such as myoepithelioma (ME) and myoepithelial carcinoma (MC), clear cell carcinoma (CCC), mucoepidermoid carcinoma (MEC), acinic cell carcinoma (AciCC), secretory carcinoma (SC).
It is a an unusual tumour of major salivary gland predominantly occurring in parotid (60–80%) but can also be seen in minor SGS [20]. Palate is the most common site of occurrence and clinical presentation can be a ulcerative nodular lesion.
10a: Smear showing admixture of dual population of cells comprising of epithelial and myoepithelial cells in a case of epithelial myoepithelial carcinoma (Haematoxylin & Eosin x 40), 10b:s Smear showing a cluster of cells with multilayering of round to polygonal oncocytic cells (arrow) with round nucleus and abundant dense granular cytoplasm in a case of an oncocytoma (May-Grunwald Giemsa stain x 40)
Clear cells can be encountered in MEC of minor SGs. However, identification of other accompanying cells (intermediate and epidermoid cells) in MEC gives clues to the diagnosis [34]. Mucin in cells of MEC can also be demonstrated by mucicarmine stain on cell blocks.
It is a low-grade tumour having predominantly vacuolated cell morphology. AciCC predominantly occurs in parotid (75–90%) and the remaining cases occur in intraoral minor salivary glands predominantly in buccal mucosa [39].
Sometimes, aspirates from non-neoplastic SG tissue may resemble cells of AciCC. Single stripped nucleus of non-neoplastic SG may be difficult to distinguish from AciCC. However, cell groups and clusters of AciCC can be identified as they show three dimensional architecture with overlapping unlike the regularly arranged acini attached to duct with a thin fibrovascular core in a normal non-neoplastic SG tissue [40].
Sebaceous adenoma (SA) and sebaceous lymphadenoma are benign tumours and can occur in minor SGs and also have cells with vacuolated to clear cytoplasm [42]. Similarly, sebaceous carcinoma may arise rarely in intraoral SGs. The cells of these tumours contain cytoplasmic fat which can be demonstrated by oil-red O staining. PAS-D staining is negative for zymogen granules as seen in AciCC.
Cells of AciCC may show oncocyte like changes and sometimes resemble an oncocytoma. However, the typical cells of AciCC with finely vacuolated delicate cytoplasm can be identified. Many stripped or bare nuclei are also seen which are absent in oncocytoma [40]. Cell block preparation can be used to demonstrate periodic acid Schiff with diastase (PAS-D) positive zymogen granules in AciCC. Also, if oncocytoma is suspected, then phosphotungstic acid-haematoxylin (PTAH) stain can be done on cell blocks which shows strong positive cytoplasmic staining due to presence of abundant mitochondria.
AciCC may show clear cells which may resemble other tumours with clear cells such as EMC. The biphasic population of myoepithelial and epithelial cell can identified in EMC. The key cytological features of EMC are discussed at 4.3.1.
Previously called as mammary analogue secretory carcinoma, it is a new subtype of SG carcinoma and is reported to occur in minor salivary gland [43]. It also shows cells with vacuolated to clear cytoplasm.
Oncocytoma is a benign tumours of SG predominantly occurring in parotid. However, these tumours are also known to occur in intraoral minor SGs [44].
The presence of oncocytes can be seen in other tumours of SGs particularly acinic cell carcinoma (AciCC) and less commonly in mucoepidermoid carcinoma (MEC) [40, 45, 46]. The distinguishing features of oncocytoma from AciCC are discussed at 4.3.5c.
Intraoral PA may also undergo metaplastic oncocytic change through a process known as oncocytosis. Oncocytosis is characterized by metaplastic change in SGs. Sometimes, entire salivary gland parenchyma is replaced by oncocytes mimicking an oncocytoma [45, 46]. But the typical metachromatic fibrillary matrix can usually be identified after adequate sampling in PA.
Oncocytic variant of mucoepidermoid carcinoma (OMEC) is a low-grade tumour and may resemble an oncocytoma as it shows bland oncocytic cells with minimal nuclear atypia [47]. However, it shows characteristic mucinous goblet cells of MEC. Also, epidermoid and intermediate cells should always be searched upon, if OMEC is suspected. Cell block can also be used to confirm mucin in goblet cells by mucicarmine staining.
Oncocytic carcinoma is a rare aggressive carcinoma and may develop in pre-existing oncocytoma. However, it can be distinguished from oncocytoma as it shows atypical oncocytic cells with nuclear pleomorphism. Mitosis and necrosis can also be seen.
Warthin’s Tumour constitutes 5–15% of all salivary gland tumours. Although, it shows cohesive two or three- dimensional clusters of oncocytic cells resembling an oncocytoma but it occurs almost exclusively within the parotid gland [46]. The background is usually cystic with debris, lymphocytes and lympho-histiocytes.
It is an aggressive invasive tumour showing features that are not specific for any particular tumour type. It is a usually a diagnosis of exclusion. It constitutes 10–15% of all SG tumours and about 40% cases are reported in minor salivary glands with palate being the most common site [48].
Other SG carcinomas such as salivary duct carcinomas, intraductal carcinoma, lymphoepithelial carcinoma, primary squamous cell carcinoma and carcinosarcomas are rare and are reported to occur in major salivary gland and not in intraoral minor SGs.
Amongst non-neoplastic lesions, mucocele or mucous retention cyst occur in intraoral SGs and can mimic a low-grade cystic tumour. Mucocele is a pseudocyst which lack epithelial lining and contain extravasated mucin. These usually develops in minor SGs particularly on the lips and other sites such as tongue [49]. FNAC smears from mucocele are hypocellular with histiocytes and muciphages in an abundant mucoid background. Few giant cells can also be seen. Cystic consistency and mucoid background with muciphages may raise a possibility of low-grade MEC but other features of MEC such as intermediate and epidermoid cells are absent.
Inflammation of SGs may result from various causes but predominantly it occurs due to stenosis or obstruction of SG ducts because of sialolithiasis, trauma or secondary involvement by tumours [51, 52]. It may present with swelling and sometimes mimic a neoplasm.
FNAC of intraoral SGs is challenging. There are many diagnostic challenges encountered in cytopathology of SG tumours as these tumours show morphological diversity and overlapping features with other neoplastic and non-neoplastic lesions. Careful assessment of morphological features with acquaintance of diagnostic challenges and pitfalls not only aid in avoiding misdiagnosis but also aid in planning further management and treatment.
We acknowledge Professor Vaishali Walke, Dr. Deepti Joshi, Dr. Ujjawal Khurana for contribution of images. We also thanks all the faculty of department of Pathology & Lab Medicine, AIIMS, Bhopal for their support during preparation of this chapter.
The authors declare no conflict of interest for this chapter.
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\\n\\nThe application process is open after your submitted manuscript has been accepted for publication. To apply, please fill out a Waiver Request Form and send it to your Author Service Manager. If you have an official letter from your university or institution showing that funds for your OA publication are unavailable, please attach that as well. The Waiver Request will normally be addressed within one week from the application date. All chapters that receive waivers or partial waivers will be designated as such online.
\\n\\nDownload Waiver Request Form
\\n\\nFeel free to contact us at funders@intechopen.com if you have any questions about Funding options or our Waiver program. If you have already begun the process and require further assistance, please contact your Author Service Manager, who is there to assist you!
\\n\\nNote: All data represented above was collected by IntechOpen from 2013 to 2017.
\\n"}]'},components:[{type:"htmlEditorComponent",content:'At IntechOpen, the majority of OAPFs are paid by an Author’s institution or funding agency - Institutions (73%) vs. Authors (23%).
\n\nThe first step in obtaining funds for your Open Access publication begins with your institution or library. IntechOpen’s publishing standards align with most institutional funding programs. Our advice is to petition your institution for help in financing your Open Access publication.
\n\nHowever, as Open Access becomes a more commonly used publishing option for the dissemination of scientific and scholarly content, in addition to institutions, there are a growing number of funders who allow the use of grants for covering OA publication costs, or have established separate funds for the same purpose.
\n\nPlease consult our Open Access Funding page to explore some of these funding opportunities and learn more about how you could finance your IntechOpen publication. Keep in mind that this list is not definitive, and while we are constantly updating and informing our Authors of new funding opportunities, we recommend that you always check with your institution first.
\n\nFor Authors who are unable to obtain funding from their institution or research funding bodies and still need help in covering publication costs, IntechOpen offers the possibility of applying for a Waiver.
\n\nOur mission is to support Authors in publishing their research and making an impact within the scientific community. Currently, 14% of Authors receive full waivers and 6% receive partial waivers.
\n\nWhile providing support and advice to all our international Authors, waiver priority will be given to those Authors who reside in countries that are classified by the World Bank as low-income economies. In this way, we can help ensure that the scientific work being carried out can make an impact within the worldwide scientific community, no matter where an Author might live.
\n\nThe application process is open after your submitted manuscript has been accepted for publication. To apply, please fill out a Waiver Request Form and send it to your Author Service Manager. If you have an official letter from your university or institution showing that funds for your OA publication are unavailable, please attach that as well. The Waiver Request will normally be addressed within one week from the application date. All chapters that receive waivers or partial waivers will be designated as such online.
\n\nDownload Waiver Request Form
\n\nFeel free to contact us at funders@intechopen.com if you have any questions about Funding options or our Waiver program. If you have already begun the process and require further assistance, please contact your Author Service Manager, who is there to assist you!
\n\nNote: All data represented above was collected by IntechOpen from 2013 to 2017.
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He is a member of the Turkish Biochemical Society, American Chemical Society, and German Genetics society. Dr. Ekinci published around ninety scientific papers, reviews and book chapters, and presented several conferences to scientists. He has received numerous publication awards from several scientific councils. 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