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Presented by Dr. Cimino-Mathews and prepared by Dr. Austin McCuiston.
Clinical history: A 60 year-old male with a parotid mass.
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1. Question
Clinical history: A 60 year-old male with a parotid mass.
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Answer: Acinic cell carcinoma with high grade transformation
Histology: The resection specimen shows a serous salivary gland, consistent with the parotid gland. In it, there is a lesion comprised predominantly of small to large infiltrating nests of malignant epithelial cells with central comedo-type necrosis. The nests of cells display solid, cribriform and rosette-like architecture. The cells display nuclear atypia with a brisk mitotic rate, and the cytoplasm is primarily eosinophilic with focal blue zymogen granules. Perineural invasion is identified. Adjacent to this high grade component, a lower grade component is identified consisting of cells with bland nuclei, prominent granular cytoplasm, and a microcystic growth pattern.
Discussion: The histology of the low grade component is characteristic of acinic cell carcinoma of the parotid salivary gland, and the presence of the high grade component is consistent with high grade transformation of acinic cell carcinoma. High grade transformation can be seen in otherwise low grade malignant salivary gland neoplasms, which is contrast to malignancy arising from a pre-existing benign tumor as seen in carcinoma ex pleomorphic adenoma. Acinic cell carcinomas of the salivary glands arise from the serous acinar cells, thus most acinic cell carcinomas arise in the parotid gland, which is contains exclusively serous acini. In contrast, the sublingual gland has exclusively mucinous acini, the submandibular gland has mixed serous and mucinous aciniand the minor salivary glands are largely mixed. In fact, many acinic cell carcinomas previously diagnosed in non-parotid salivary glands turn out to be mammary analog secretory carcinomas, which histologically mimic acinic cell carcinomas due to the microcystic architecture but are distinct and in fact harbor fusions in ETV6.
Reference(s):
– Bishop JA, Yonescu R, Batista D, Eisele DW, Westra WH. Most nonparotid “acinic cell carcinomas” represent mammary analog secretory carcinomas. Am J Surg Pathol. 2013 Jul;37(7):1053-7.
– Zarbo RJ. Salivary Gland Neoplasia: A Review for the Practicing Pathologist Mod Pathol 2002;15(3):298–323.Incorrect
Answer: Acinic cell carcinoma with high grade transformation
Histology: The resection specimen shows a serous salivary gland, consistent with the parotid gland. In it, there is a lesion comprised predominantly of small to large infiltrating nests of malignant epithelial cells with central comedo-type necrosis. The nests of cells display solid, cribriform and rosette-like architecture. The cells display nuclear atypia with a brisk mitotic rate, and the cytoplasm is primarily eosinophilic with focal blue zymogen granules. Perineural invasion is identified. Adjacent to this high grade component, a lower grade component is identified consisting of cells with bland nuclei, prominent granular cytoplasm, and a microcystic growth pattern.
Discussion: The histology of the low grade component is characteristic of acinic cell carcinoma of the parotid salivary gland, and the presence of the high grade component is consistent with high grade transformation of acinic cell carcinoma. High grade transformation can be seen in otherwise low grade malignant salivary gland neoplasms, which is contrast to malignancy arising from a pre-existing benign tumor as seen in carcinoma ex pleomorphic adenoma. Acinic cell carcinomas of the salivary glands arise from the serous acinar cells, thus most acinic cell carcinomas arise in the parotid gland, which is contains exclusively serous acini. In contrast, the sublingual gland has exclusively mucinous acini, the submandibular gland has mixed serous and mucinous aciniand the minor salivary glands are largely mixed. In fact, many acinic cell carcinomas previously diagnosed in non-parotid salivary glands turn out to be mammary analog secretory carcinomas, which histologically mimic acinic cell carcinomas due to the microcystic architecture but are distinct and in fact harbor fusions in ETV6.
Reference(s):
– Bishop JA, Yonescu R, Batista D, Eisele DW, Westra WH. Most nonparotid “acinic cell carcinomas” represent mammary analog secretory carcinomas. Am J Surg Pathol. 2013 Jul;37(7):1053-7.
– Zarbo RJ. Salivary Gland Neoplasia: A Review for the Practicing Pathologist Mod Pathol 2002;15(3):298–323.
