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Presented by Pedram Argani, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 1: 38 year old female with a neck mass.
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1. Question
Week 234: Case 1
38 year old female with a neck massimages/8.9.05case11.jpg
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images/8.9.05case15.jpgCorrect
Answer: Acinic cell carcinoma
Histology: The tumor has a predominantly microcystic architecture. The lesion has a prominent fibrous wall, and is solid and composed of predominantly vacuolated cells and nonspecific glandular cells.
Discussion: A mucoepidermoid carcinoma would demonstrate areas of squamous differentiation and intracytoplasmic mucin. A metastatic thyroid carcinoma would label for TTF-1 and thyroglobulin, and would demonstrate follicular formations or papillary structures with optically clear nuclei. Metastatic renal cell carcinoma would be hypervascular, and composed of cells with completely clear cytoplasm.
Acinic cell carcinoma is a low grade carcinoma for which stage is the most crucial prognostic factor. However, the architecture and cytology can vary, causing diagnostic confusion. The architecture may be solid, microcystic, papillocystic or follicular, while the cytology can have acinic cells, intercalated duct cells, vacuolated cells, clear cells, and nonspecific glandular cells. Hence, acinic cell carcinoma enters into the differential of most unusual salivary gland neoplasms.
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Incorrect
Answer: Acinic cell carcinoma
Histology: The tumor has a predominantly microcystic architecture. The lesion has a prominent fibrous wall, and is solid and composed of predominantly vacuolated cells and nonspecific glandular cells.
Discussion: A mucoepidermoid carcinoma would demonstrate areas of squamous differentiation and intracytoplasmic mucin. A metastatic thyroid carcinoma would label for TTF-1 and thyroglobulin, and would demonstrate follicular formations or papillary structures with optically clear nuclei. Metastatic renal cell carcinoma would be hypervascular, and composed of cells with completely clear cytoplasm.
Acinic cell carcinoma is a low grade carcinoma for which stage is the most crucial prognostic factor. However, the architecture and cytology can vary, causing diagnostic confusion. The architecture may be solid, microcystic, papillocystic or follicular, while the cytology can have acinic cells, intercalated duct cells, vacuolated cells, clear cells, and nonspecific glandular cells. Hence, acinic cell carcinoma enters into the differential of most unusual salivary gland neoplasms.
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