Difference between revisions of "Acinic cell carcinoma"
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| LMDDx = [[oncocytoma of the salivary gland]], [[mucoepidermoid carcinoma]], adenocarcinoma NOS, [[secretory carcinoma of the salivary gland]] | | LMDDx = [[oncocytoma of the salivary gland]], [[mucoepidermoid carcinoma]], adenocarcinoma NOS, [[secretory carcinoma of the salivary gland]] | ||
| Stains = PAS +ve, PASD +ve | | Stains = PAS +ve, PASD +ve | ||
| IHC = p63 -ve, S-100 -ve | | IHC = p63 -ve, S-100 -ve, CK7 +ve, CK19 +ve, NR4A3 +ve, alpha1-ACT +ve | ||
| EM = [[zymogen granules]] | | EM = [[zymogen granules]] | ||
| Molecular = t(4;9)(q13;q31) | | Molecular = t(4;9)(q13;q31) | ||
Revision as of 16:10, 27 October 2021
| Acinic cell carcinoma | |
|---|---|
| Diagnosis in short | |
 Acinic cell carcinoma. H&E stain. | |
|
| |
| LM | "acinic cells" (abundant finely vacuolated cytoplasm with basophilic granules, small nuclei with stippled chromatin), scattered "intercalcated duct type cells" (eosinophilic cytoplasm with moderate amount of cytoplasm and bland nuclei), +/-peri-tumoural lymphocytes, +/-glassy extracellular bluish/purple blobs |
| Subtypes | oncocytic variant, clear cell variant, papillary cystic variant |
| LM DDx | oncocytoma of the salivary gland, mucoepidermoid carcinoma, adenocarcinoma NOS, secretory carcinoma of the salivary gland |
| Stains | PAS +ve, PASD +ve |
| IHC | p63 -ve, S-100 -ve, CK7 +ve, CK19 +ve, NR4A3 +ve, alpha1-ACT +ve |
| EM | zymogen granules |
| Molecular | t(4;9)(q13;q31) |
| Gross | tan or reddish |
| Site | salivary gland - usu. parotid gland |
|
| |
| Signs | salivary gland mass |
| Prevalence | uncommon |
| Prognosis | good |
Acinic cell carcinoma, abbreviated AcCC, is a rare type of salivary gland cancer. It is also known as acinic cell adenocarcinoma.
It should not to be confused with pancreatic acinar cell carcinoma.
General
- Malignant neoplasm of salivary gland arising from acinic cells.
- The relative prevalence of the neoplasm in the various salivary gland reflects the abundance of acinic cells: parotid gland (~80%) > minor salivary glands (~17%) > submandibular glands (~3%).
- Affects wide age range -- including children.
- Site affect prognosis (most aggressive to least aggressive): submandibular > parotid > minor salivary.
- Good prognosis - in one large cohort:[1]
- ~97% five year survival.
- ~93% 10 year survival.
Gross
- Tan or reddish.
Microscopic
Features:
- Sheets of acinic cells with:
- Abundant finely vacuolated cytoplasm with basophilic granules - key feature.
- Granules may be focal.
- Small nuclei stippled chromatin.
- Abundant finely vacuolated cytoplasm with basophilic granules - key feature.
- Scattered intercalcated duct type cells with:
- Eosinophilic cytoplasm with moderate amount of cytoplasm.
- Bland nuclei with slightly larger than seen in acinic cells.
- +/-Peri-tumoural lymphocytes.
- +/-Glassy extracellular bluish/purple blobs.
Notes:
- Adipose tissue -- present in the salivary glands -- is absent in AcCC.
- May focally resemble thyroid tissue.
- Smaller (characteristic) microvacuoles (unreported in the literature) may be present that have a bubbly appearance and glassy basophilic inclusions.[2]
Memory device:
- AcCC - lots of "C"s - chromatin stipled, cytoplasm generous.
DDx:
- Oncocytoma of the salivary gland.
- Adenocarcinoma not otherwise specified.[3]
- Secretory carcinoma of the salivary gland (previously mammary analogue secretory carcinoma).[4]
Images
Case
AcCC - intermed. mag. (WC/Nephron)
AcCC - high mag. (WC/Nephron)
AcCC - very high mag. (WC/Nephron)
Case
AcCC - low mag. (WC/Nephron)
AcCC - intermed. mag. (WC/Nephron)
AcCC - high mag. (WC/Nephron)
AcCC - very high mag. (WC/Nephron)
AcCC - very high mag. (WC/Nephron)
www
Grading
General:
- Not prognostic.
- Done to avoid phone calls from clinician.
Factors Weinreb uses:[2]
- Necrosis.
- Nuclear atypia.
- Perineural invasion.
- Mitoses.
- Infiltrative margin.
- Tumour sclerosis.
Subtypes
- Oncocytic variant - rare.
- Clear cell variant - rare.
- Papillary cystic variant.
Stains
- PAS +ve.
- PAS-D +ve.
IHC
- CK7 +ve.[5]
- CK19 +ve.[5]
- S-100 -ve.
- p63 -ve (30 -ve of 30 cases[6]).
- p63 +ve in mucoepidermoid carcinoma (24 +ve of 24 cases).[6]
- NR4A3 +ve (nuclear) (5 of 6 cases[7]).
There are a bunch of other stains that are touted to be useful (amylase, anti-chymotrypsin, lactoferrin). Weinreb thinks these are not helpful.[2]
Molecular
- t(4;9)(q13;q31).[7]
EM
Sign out
A. Tumour, Left Parotid Gland, Excision: - ACINIC CELL CARCINOMA, see comment. -- Margins clear. -- Please see synoptic report. B. Lymph Nodes, Left - Level 2 & 3, Lymphadenectomy: - Five lymph nodes NEGATIVE for malignancy (0/5). Comment: Immunostains are in keeping with acinic cell carcinoma (mammaglobin, S-100 and p63 are all NEGATIVE). A PAS stain is positive in the tumour.
See also
References
- ↑ Patel, NR.; Sanghvi, S.; Khan, MN.; Husain, Q.; Baredes, S.; Eloy, JA. (Jan 2014). "Demographic trends and disease-specific survival in salivary acinic cell carcinoma: an analysis of 1129 cases.". Laryngoscope 124 (1): 172-8. doi:10.1002/lary.24231. PMID 23754708.
- ↑ 2.0 2.1 2.2 IW. 11 January 2011.
- ↑ Ihrler, S.; Blasenbreu-Vogt, S.; Sendelhofert, A.; Lang, S.; Zietz, C.; Löhrs, U. (2002). "Differential diagnosis of salivary acinic cell carcinoma and adenocarcinoma (NOS). A comparison of (immuno-)histochemical markers.". Pathol Res Pract 198 (12): 777-83. PMID 12608654.
- ↑ Lei, Y.; Chiosea, SI. (Jun 2012). "Re-evaluating historic cohort of salivary acinic cell carcinoma with new diagnostic tools.". Head Neck Pathol 6 (2): 166-70. doi:10.1007/s12105-011-0312-9. PMID 22127547.
- ↑ 5.0 5.1 "Immunohistochemical expression of cytokeratins in human salivary gland acinic cell carcinomas". Oral Surg Oral Med Oral Pathol Oral Radiol 120 (2): 248–57. August 2015. doi:10.1016/j.oooo.2015.04.014. PMID 26166029.
- ↑ 6.0 6.1 Sams, RN.; Gnepp, DR. (Mar 2013). "P63 expression can be used in differential diagnosis of salivary gland acinic cell and mucoepidermoid carcinomas.". Head Neck Pathol 7 (1): 64-8. doi:10.1007/s12105-012-0403-2. PMID 23054955.
- ↑ 7.0 7.1 "NR4A3 (NOR-1) Immunostaining Shows Better Performance than DOG1 Immunostaining in Acinic Cell Carcinoma of Salivary Gland: a Preliminary Study". J Oral Maxillofac Res 12 (1): e4. 2021. doi:10.5037/jomr.2021.12104. PMC 8085676. PMID 33959239. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085676/.
- ↑ 8.0 8.1 "Enhancer hijacking activates oncogenic transcription factor NR4A3 in acinic cell carcinomas of the salivary glands". Nat Commun 10 (1): 368. January 2019. doi:10.1038/s41467-018-08069-x. PMC 6341107. PMID 30664630. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6341107/.
- ↑ Sun, Y.; Wasserman, PG. (Feb 2004). "Acinar cell carcinoma arising in the stomach: a case report with literature review.". Hum Pathol 35 (2): 263-5. PMID 14991547.