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Presented by Pedram Argani, M.D. and prepared by Orin Buetens, M.D.
Case 6: 23-year-old female with a neck mass.
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1. Question
Week 12: Case 6
23-year-old female with a neck mass.
Correct
Answer: Acinic cell adenocarcinoma
Histology: The tumor is composed of sheets of predominantly serous (acinic) cells which are associated with dense bands of fibroses and lymphoid reaction. Occasional cells show vacuolization which gives rise to a microcystic pattern. Striated ducts are not present within the tumor.
Discussion: When they are composed of predominantly acinic cells, acinic cell adenocarcinomas can be difficult to distinguish from normal parotid gland tissue. The absence of striated ducts, the presence of stromal fibrosis, a polygonal cell shape (as opposed to the triangular appearance of normal acinar cells), and the lack of a normal lobular pattern favor carcinoma. Acinic cell carcinomas are often associated with a lymphoid reaction often designated TALP (Tumor-Associated Lymphoid Proliferation). This raises the differential diagnosis of a metastasis to intraparotid lymph nodes. TALP, unlike lymph nodes, lacks a fibrous capsule and a subcapsular sinus. Oncocytomas are composed of polygonal cells with granular eosinophilic cytoplasm which differs from the intensely basophilic cytoplasm of acinic cell adenocarcinomas.
Incorrect
Answer: Acinic cell adenocarcinoma
Histology: The tumor is composed of sheets of predominantly serous (acinic) cells which are associated with dense bands of fibroses and lymphoid reaction. Occasional cells show vacuolization which gives rise to a microcystic pattern. Striated ducts are not present within the tumor.
Discussion: When they are composed of predominantly acinic cells, acinic cell adenocarcinomas can be difficult to distinguish from normal parotid gland tissue. The absence of striated ducts, the presence of stromal fibrosis, a polygonal cell shape (as opposed to the triangular appearance of normal acinar cells), and the lack of a normal lobular pattern favor carcinoma. Acinic cell carcinomas are often associated with a lymphoid reaction often designated TALP (Tumor-Associated Lymphoid Proliferation). This raises the differential diagnosis of a metastasis to intraparotid lymph nodes. TALP, unlike lymph nodes, lacks a fibrous capsule and a subcapsular sinus. Oncocytomas are composed of polygonal cells with granular eosinophilic cytoplasm which differs from the intensely basophilic cytoplasm of acinic cell adenocarcinomas.
