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Presented by Dr. Pedram Argani and prepared by Dr. Robby Jones
This is a 52 year old female who presents with widespread metastatic cancer and is found to have a parotid tumor which is excised.
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1. Question
This is a 52 year old female who presents with widespread metastatic cancer and is found to have a parotid tumor which is excised.
Correct
Answer: Acinic cell carcinoma with high grade transformation
Histology:
Histologic Description: The submitted tissue represents a salivary gland with prominent tumor associated lymphoid proliferation, not a lymph node. The neoplasm has two components. One component is a fairly typical acinic cell carcinoma, featuring tubules, and cribriform areas of cells with abundant purple zymogen granules. These areas are low grade. Adjacent to this is a high grade basaloid carcinoma, with abundant mitotic activity and central necrosis. These are the characteristic features high grade transformation of acinic cell carcinoma. Unlike most acinic cell carcinomas which are low grade carcinomas, high grade transformation of acinic cell carcinoma is associated with metastasis and aggressive behavior (Skalova et al Am J Surg Pathol 2009; 33:1137-1145). The high grade component is likely responsibility for the disseminated tumor in this case.
Differential Diagnosis: Salivary duct carcinoma would typically have a morphologic appearance resembling that of an apocrine breast carcinoma with areas resembling comedo ductal carcinoma in situ. The areas of acinic cell differentiation seen in this case exclude that diagnosis. Metastatic HPV-related squamous cell carcinoma could be suggested by the high grade areas of this tumor, but that diagnosis does not account for the low grade acinic cell component of this case. Mammary analog secretory carcinomas is often confused with acinic cell carcinoma; however, it is essentially a low grade lesion which is morphologically and genetically identical to secretory carcinoma of the breast, and lacks the high grade component and acinic cell differentiation of the current lesion.Incorrect
Answer: Acinic cell carcinoma with high grade transformation
Histology:
Histologic Description: The submitted tissue represents a salivary gland with prominent tumor associated lymphoid proliferation, not a lymph node. The neoplasm has two components. One component is a fairly typical acinic cell carcinoma, featuring tubules, and cribriform areas of cells with abundant purple zymogen granules. These areas are low grade. Adjacent to this is a high grade basaloid carcinoma, with abundant mitotic activity and central necrosis. These are the characteristic features high grade transformation of acinic cell carcinoma. Unlike most acinic cell carcinomas which are low grade carcinomas, high grade transformation of acinic cell carcinoma is associated with metastasis and aggressive behavior (Skalova et al Am J Surg Pathol 2009; 33:1137-1145). The high grade component is likely responsibility for the disseminated tumor in this case.
Differential Diagnosis: Salivary duct carcinoma would typically have a morphologic appearance resembling that of an apocrine breast carcinoma with areas resembling comedo ductal carcinoma in situ. The areas of acinic cell differentiation seen in this case exclude that diagnosis. Metastatic HPV-related squamous cell carcinoma could be suggested by the high grade areas of this tumor, but that diagnosis does not account for the low grade acinic cell component of this case. Mammary analog secretory carcinomas is often confused with acinic cell carcinoma; however, it is essentially a low grade lesion which is morphologically and genetically identical to secretory carcinoma of the breast, and lacks the high grade component and acinic cell differentiation of the current lesion.
