Difference between revisions of "Acinic cell carcinoma"

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Acinic cell carcinoma (view source)

Revision as of 16:54, 27 October 2021

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| Micro      = "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
| Micro      = "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
| Subtypes  = oncocytic variant, clear cell variant, papillary cystic variant
| LMDDx      = [[oncocytoma of the salivary gland]], [[mucoepidermoid carcinoma]], adenocarcinoma NOS, [[mammary analogue secretory carcinoma]]
| 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  =
| Molecular  = t(4;9)(q13;q31)
| IF        =
| IF        =
| Gross      = tan or reddish
| Gross      = tan or reddish
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*[[Oncocytoma of the salivary gland]].
*[[Oncocytoma of the salivary gland]].
*Adenocarcinoma not otherwise specified.<ref name=pmid12608654>{{Cite journal  | last1 = Ihrler | first1 = S. | last2 = Blasenbreu-Vogt | first2 = S. | last3 = Sendelhofert | first3 = A. | last4 = Lang | first4 = S. | last5 = Zietz | first5 = C. | last6 = Löhrs | first6 = U. | title = Differential diagnosis of salivary acinic cell carcinoma and adenocarcinoma (NOS). A comparison of (immuno-)histochemical markers. | journal = Pathol Res Pract | volume = 198 | issue = 12 | pages = 777-83 | month =  | year = 2002 | doi =  | PMID = 12608654 }}</ref>
*Adenocarcinoma not otherwise specified.<ref name=pmid12608654>{{Cite journal  | last1 = Ihrler | first1 = S. | last2 = Blasenbreu-Vogt | first2 = S. | last3 = Sendelhofert | first3 = A. | last4 = Lang | first4 = S. | last5 = Zietz | first5 = C. | last6 = Löhrs | first6 = U. | title = Differential diagnosis of salivary acinic cell carcinoma and adenocarcinoma (NOS). A comparison of (immuno-)histochemical markers. | journal = Pathol Res Pract | volume = 198 | issue = 12 | pages = 777-83 | month =  | year = 2002 | doi =  | PMID = 12608654 }}</ref>
*[[Mammary analogue secretory carcinoma]].<ref name=pmid22127547>{{Cite journal  | last1 = Lei | first1 = Y. | last2 = Chiosea | first2 = SI. | title = Re-evaluating historic cohort of salivary acinic cell carcinoma with new diagnostic tools. | journal = Head Neck Pathol | volume = 6 | issue = 2 | pages = 166-70 | month = Jun | year = 2012 | doi = 10.1007/s12105-011-0312-9 | PMID = 22127547 }}</ref>
*[[Secretory carcinoma of the salivary gland]] (previously ''mammary analogue secretory carcinoma).<ref name=pmid22127547>{{Cite journal  | last1 = Lei | first1 = Y. | last2 = Chiosea | first2 = SI. | title = Re-evaluating historic cohort of salivary acinic cell carcinoma with new diagnostic tools. | journal = Head Neck Pathol | volume = 6 | issue = 2 | pages = 166-70 | month = Jun | year = 2012 | doi = 10.1007/s12105-011-0312-9 | PMID = 22127547 }}</ref>


===Images===
===Images===
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====www====
====www====
*[http://www.surgicalpathologyatlas.com/glfusion/mediagallery/media.php?f=0&sort=0&s=20080802170246445 AcCC (surgicalpathologyatlas.com)].
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/acinic.html AcCC (brown.edu)].
*[http://www.brown.edu/Courses/Digital_Path/systemic_path/hn/acinic.html AcCC (brown.edu)].
*[http://www.aciniccell.org/acc_images14.html AcCC (aciniccell.org)] - image collection.


===Grading===
===Grading===
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*Nuclear atypia.
*Nuclear atypia.
*[[Perineural invasion]].
*[[Perineural invasion]].
*[[Mitoses]].
*Mitoses.
*Infiltrative margin.
*Infiltrative margin.
*Tumour sclerosis.
*Tumour sclerosis.
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==IHC==
==IHC==
*CK7 +ve.<ref name=pmid26166029>{{cite journal |authors=Li X, Shi Z, Wang Y, Liu Y, Liu T |title=Immunohistochemical expression of cytokeratins in human salivary gland acinic cell carcinomas |journal=Oral Surg Oral Med Oral Pathol Oral Radiol |volume=120 |issue=2 |pages=248–57 |date=August 2015 |pmid=26166029 |doi=10.1016/j.oooo.2015.04.014 |url=}}</ref>
*CK19 +ve.<ref name=pmid26166029/>
*NR4A3 +ve (nuclear) (5 of 6 cases<ref name=pmid33959239>{{cite journal |authors=Owosho A, Tyler D, Adesina O, Odujoko O, Summersgill K |title=NR4A3 (NOR-1) Immunostaining Shows Better Performance than DOG1 Immunostaining in Acinic Cell Carcinoma of Salivary Gland: a Preliminary Study |journal=J Oral Maxillofac Res |volume=12 |issue=1 |pages=e4 |date=2021 |pmid=33959239 |pmc=8085676 |doi=10.5037/jomr.2021.12104 |url=}}</ref>; 18 of 20 cell blocks<ref name=pmid26166029>{{cite journal |authors=Li X, Shi Z, Wang Y, Liu Y, Liu T |title=Immunohistochemical expression of cytokeratins in human salivary gland acinic cell carcinomas |journal=Oral Surg Oral Med Oral Pathol Oral Radiol |volume=120 |issue=2 |pages=248–57 |date=August 2015 |pmid=26166029 |doi=10.1016/j.oooo.2015.04.014 |url=}}</ref>; 9 of 9 surgicals<ref name=pmid26166029/>).
*Alpha1-ACT (also ''AACT'') +ve.
Negative:
*S-100 -ve.
*S-100 -ve.
*p63 -ve (30 -ve of 30 cases<ref name=pmid23054955/>).
*p63 -ve (30 -ve of 30 cases<ref name=pmid23054955/>).
**p63 +ve in [[mucoepidermoid carcinoma]] (24 +ve of 24 cases).<ref name=pmid23054955>{{Cite journal  | last1 = Sams | first1 = RN. | last2 = Gnepp | first2 = DR. | title = P63 expression can be used in differential diagnosis of salivary gland acinic cell and mucoepidermoid carcinomas. | journal = Head Neck Pathol | volume = 7 | issue = 1 | pages = 64-8 | month = Mar | year = 2013 | doi = 10.1007/s12105-012-0403-2 | PMID = 23054955 }}</ref>
**p63 +ve in [[mucoepidermoid carcinoma]] (24 +ve of 24 cases<ref name=pmid23054955>{{Cite journal  | last1 = Sams | first1 = RN. | last2 = Gnepp | first2 = DR. | title = P63 expression can be used in differential diagnosis of salivary gland acinic cell and mucoepidermoid carcinomas. | journal = Head Neck Pathol | volume = 7 | issue = 1 | pages = 64-8 | month = Mar | year = 2013 | doi = 10.1007/s12105-012-0403-2 | PMID = 23054955 }}</ref>).


There are a bunch of other [[stains]] that are touted to be useful (amylase, anti-chymotrypsin, lactoferrin). Weinreb thinks these are '''not''' helpful.<ref name=IW_10jan2011>IW. 11 January 2011.</ref>
A panel: CK7, CK19, AACT, mammaglobin, S-100, GATA3.
 
==Molecular==
*t(4;9)(q13;q31).<ref name=pmid33959239>{{cite journal |authors=Owosho A, Tyler D, Adesina O, Odujoko O, Summersgill K |title=NR4A3 (NOR-1) Immunostaining Shows Better Performance than DOG1 Immunostaining in Acinic Cell Carcinoma of Salivary Gland: a Preliminary Study |journal=J Oral Maxillofac Res |volume=12 |issue=1 |pages=e4 |date=2021 |pmid=33959239 |pmc=8085676 |doi=10.5037/jomr.2021.12104 |url=}}</ref>
**''Secretory Ca-binding phosphoprotein'' (SCPP) at 4q13.<ref name=pmid30664630>{{cite journal |authors=Haller F, Bieg M, Will R, Körner C, Weichenhan D, Bott A, Ishaque N, Lutsik P, Moskalev EA, Mueller SK, Bähr M, Woerner A, Kaiser B, Scherl C, Haderlein M, Kleinheinz K, Fietkau R, Iro H, Eils R, Hartmann A, Plass C, Wiemann S, Agaimy A |title=Enhancer hijacking activates oncogenic transcription factor NR4A3 in acinic cell carcinomas of the salivary glands |journal=Nat Commun |volume=10 |issue=1 |pages=368 |date=January 2019 |pmid=30664630 |pmc=6341107 |doi=10.1038/s41467-018-08069-x |url=}}</ref>
**''Nuclear Receptor Subfamily 4 Group A Member 3'' (NR4A3) at 9q31.<ref name=pmid30664630/>


==EM==
==EM==
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Comment:
Comment:
Immunostains are in keeping with acinic cell carcinoma (mammoglobin, S-100 and p63 are all NEGATIVE). A PAS stain is positive in the tumour.
The tumour stains as follows:
POSITIVE: CK7, CK19, AACT, PAS.
NEGATIVE: mammaglobin, S-100, p63.
 
The staining is in keeping with acinic cell carcinoma.
</pre>
</pre>


Michael
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