Difference between revisions of "Salivary glands"

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Salivary glands (view source)

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→‎Acinic cell carcinoma: split out
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==Acinic cell carcinoma==
==Acinic cell carcinoma==
:'''Not''' to be confused with ''[[pancreatic acinar cell carcinoma]]''.
{{Main|Acinic cell carcinoma}}
*Abbreviated ''AcCC''.
*[[AKA]] ''acinic cell adenocarcinoma''.
 
===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.
===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.
*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.<ref name=IW_10jan2011>IW. 11 January 2011.</ref>
 
Memory device:
*AcCC - lots of "C"s - '''c'''hromatin stipled, '''c'''ytoplasm generous.
 
DDx:
*[[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>
 
====Images====
<gallery>
Image:Acinic_cell_carcinoma_-_intermed_mag.jpg | AcCC - intermed. mag. (WC/Nephron)
Image:Acinic_cell_carcinoma_-_high_mag.jpg | AcCC - high mag. (WC/Nephron)
Image:Acinic_cell_carcinoma_-_very_high_mag.jpg | AcCC - very high mag. (WC/Nephron)
</gallery>
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.aciniccell.org/acc_images14.html AcCC (aciniccell.org)] - image collection.
 
====Grading====
General:
*Not prognostic.
*Done to avoid phone calls from clinician.
 
Factors Weinreb uses:<ref name=IW_10jan2011>IW. 11 January 2011.</ref>
*[[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===
*S-100 -ve.
*p63 -ve.
**p63 +ve in mucoepidermoid carcinoma.
 
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>
 
===EM===
*[[Zymogen granules]].<ref name=pmid14991547>{{Cite journal  | last1 = Sun | first1 = Y. | last2 = Wasserman | first2 = PG. | title = Acinar cell carcinoma arising in the stomach: a case report with literature review. | journal = Hum Pathol | volume = 35 | issue = 2 | pages = 263-5 | month = Feb | year = 2004 | doi =  | PMID = 14991547 }}</ref>


==Adenoid cystic carcinoma==
==Adenoid cystic carcinoma==
Michael
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