Acinic cell carcinoma differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ramyar Ghandriz MD[2]

Overview

Acinic cell carcinoma is a head and neck tumor happening in the salivary glands. If a patient was observed with related signs, the tumor must be classified as a benign or invasive by the capsule being intact. Differential diagnosis of a malignant tumor in the salivary gland is made after the incision and by histology features which will provide a good chemotherapy regimen for so-called patients.

Differentiating acinic cell carcinoma from other Diseases

  • Based on tumor site differentiation is as below:
Diseases Benign/

Malignant

Clinical manifestation Paraclinical findings Gold standard diagnosis
Demography History Symptoms Signs Lab findings Histopathology Imaging
Pain Dysphagia Mass exam Others
Pleomorphic adenoma[1][2] +
  • MRI: Homogenous on T1
  • Abundant myxochondroid stroma on T2
Warthin's tumor[3][4]
  • Male to female ratio: 4:1
  • More common in people aged 60-70 years old
+
Oncocytoma

[5]

  • Race: Caucasian patients predilection
  • Gender: No gender preference
  • Age: 50–70 years
± ±
  • CT:
    • Isodense expansive mass
    • Enhancement after intravenous contrast
    • Hypodense areas
  • MRI:
    • Isodensties on T1
    • Mass is hyperintense on T2
    • Enhancement on contrast
Monomorphic adenoma [6][7][8]
  • Age: 26-76 years
  • Rare in children
  • Gender: No predilection
± ±
  • Normal
Mucoepidermoid carcinoma

[9]

  • Age: Mean age of 59
  • Female predilection
± ±
  • Cystic and solid component with variable appearance on CT and MRI
Adenoid cystic carcinoma [10]
  • Age: 40s-60s
  • Gender: Female predominance
± ±
Adenocarcinoma

[11]

  • Age: young age predilection
Salivary duct cancer[12][13][14]

(Highly aggressive)

  • Incidence: 1-3%
  • Gender: Male predilection
  • Mean age: 55-61 years old
  • Rapidly growing mass with jaw involvement
± ±
  • Painless
  • Hard
  • Non-compressible mass
Squamous cell carcinoma[15][16]
  • Incidence: rare
  • Age: Old age , 61-68 years
  • Male predilection
  • Present as painful growing mass on jaw
+
  • Tumor dimension can be delineated using both CT and MRI

Differentiating acinic cell carcinoma from other diseases on the basis of histology findings

On the basis of histologist findings acinic cell carcinoma must be differentiated from other salivary and head and neck masses such as salivary metastasis of thyroid carcinoma, salivary oncocytoma, mucoepidermoid carcinoma, Mammary analog secretory carcinoma.[17][18]

Diseases Histological findings
Overlapping features Distinguishing features
Salivary metastasis of thyroid carcinoma[19] Empty appearance, grooves, pseudoinclusions Immunohistochemistry (Thyroglobulin)
salivary oncocytoma[20] Eosinophilic, non-serous cells Hematoxylin
mucoepidermoid carcinoma[21] Microcystic, and follicula, inconspicuous mucous/squamoid cells, eosinophilic Immunohistochemistry for p63
Mammary analoge secretory carcinoma[22] Histologically similar Lack of PAS-positive secretory granules, Vimentin positive, Adipophilin positive

References

  1. Debnath SC, Adhyapok AK (June 2010). "Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip". J Maxillofac Oral Surg. 9 (2): 205–8. doi:10.1007/s12663-010-0052-5. PMC 3244097. PMID 22190789.
  2. Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M (August 2018). "Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features". Jpn J Radiol. 36 (8): 463–471. doi:10.1007/s11604-018-0747-y. PMID 29845358.
  3. Chulam TC, Noronha Francisco AL, Goncalves Filho J, Pinto Alves CA, Kowalski LP (December 2013). "Warthin's tumour of the parotid gland: our experience". Acta Otorhinolaryngol Ital. 33 (6): 393–7. PMID 24376295.
  4. "Warthin tumor | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program".
  5. Chen B, Hentzelman JI, Walker RJ, Lai JP (2016). "Oncocytoma of the Submandibular Gland: Diagnosis and Treatment Based on Clinicopathology". Case Rep Otolaryngol. 2016: 8719030. doi:10.1155/2016/8719030. PMC 5045990. PMID 27722003.
  6. Kim KH, Sung MW, Kim JW, Koo JW (July 2000). "Pleomorphic adenoma of the trachea". Otolaryngol Head Neck Surg. 123 (1 Pt 1): 147–8. doi:10.1067/mhn.2000.102809. PMID 10889498.
  7. Pramod Krishna B (June 2013). "Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child". J Maxillofac Oral Surg. 12 (2): 228–31. doi:10.1007/s12663-010-0125-5. PMC 3681990. PMID 24431845.
  8. Kessler AT, Bhatt AA (2018). "Review of the Major and Minor Salivary Glands, Part 2: Neoplasms and Tumor-like Lesions". J Clin Imaging Sci. 8: 48. doi:10.4103/jcis.JCIS_46_18. PMC 6251244. PMID 30546932.
  9. Chenevert J, Barnes LE, Chiosea SI (February 2011). "Mucoepidermoid carcinoma: a five-decade journey". Virchows Arch. 458 (2): 133–40. doi:10.1007/s00428-011-1040-y. PMID 21243374.
  10. Jones AV, Craig GT, Speight PM, Franklin CD (April 2008). "The range and demographics of salivary gland tumours diagnosed in a UK population". Oral Oncol. 44 (4): 407–17. doi:10.1016/j.oraloncology.2007.05.010. PMID 17825603.
  11. Beltran D, Faquin WC, Gallagher G, August M (March 2006). "Selective immunohistochemical comparison of polymorphous low-grade adenocarcinoma and adenoid cystic carcinoma". J. Oral Maxillofac. Surg. 64 (3): 415–23. doi:10.1016/j.joms.2005.11.027. PMID 16487803.
  12. Mlika M, Kourda N, Zidi Y, Aloui R, Zneidi N, Rammeh S, Zermani R, Jilani SB (January 2012). "Salivary duct carcinoma of the parotid gland". J Oral Maxillofac Pathol. 16 (1): 134–6. doi:10.4103/0973-029X.92992. PMC 3303509. PMID 22434951.
  13. Schmitt NC, Kang H, Sharma A (November 2017). "Salivary duct carcinoma: An aggressive salivary gland malignancy with opportunities for targeted therapy". Oral Oncol. 74: 40–48. doi:10.1016/j.oraloncology.2017.09.008. PMC 5685667. PMID 29103750.
  14. Simpson RH (July 2013). "Salivary duct carcinoma: new developments--morphological variants including pure in situ high grade lesions; proposed molecular classification". Head Neck Pathol. 7 Suppl 1: S48–58. doi:10.1007/s12105-013-0456-x. PMC 3712088. PMID 23821208.
  15. Manvikar V, Ramulu S, Ravishanker ST, Chakravarthy C (May 2014). "Squamous cell carcinoma of submandibular salivary gland: A rare case report". J Oral Maxillofac Pathol. 18 (2): 299–302. doi:10.4103/0973-029X.140909. PMC 4196305. PMID 25328317.
  16. Ying YL, Johnson JT, Myers EN (July 2006). "Squamous cell carcinoma of the parotid gland". Head Neck. 28 (7): 626–32. doi:10.1002/hed.20360. PMID 16475198.
  17. "Tumors of the Salivary Glands, Atlas of Tumor Pathology: Third Series, Fascicle 17 G. L. Ellis and P. L. Auclair. Armed Forces Institute of Pathology, Washington D.C. ISBN: 1 881041 26 3 (Printed). 1996. Price: $69.00. ISBN: 1 881041 41 7 (CD-ROM). 1998. Price: $65.00". The Journal of Pathology. 192 (4): 564–565. 2000. doi:10.1002/1096-9896(200012)192:4<564::AID-PATH737>3.0.CO;2-M. ISSN 0022-3417.
  18. Kumar, Uma (2017). "Acinic Cell Carcinoma Papillary-Cystic Variant: Diagnostic Pitfalls in Fine Needle Aspiration Cytology". JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/JCDR/2017/21347.9772. ISSN 2249-782X.
  19. Sams, Ralph N.; Gnepp, Douglas R. (2012). "P63 Expression Can Be Used in Differential Diagnosis of Salivary Gland Acinic Cell and Mucoepidermoid Carcinomas". Head and Neck Pathology. 7 (1): 64–68. doi:10.1007/s12105-012-0403-2. ISSN 1936-055X.
  20. Schwartz, Lauren E.; Begum, Shahnaz; Westra, William H.; Bishop, Justin A. (2013). "GATA3 Immunohistochemical Expression in Salivary Gland Neoplasms". Head and Neck Pathology. 7 (4): 311–315. doi:10.1007/s12105-013-0442-3. ISSN 1936-055X.
  21. Patel, Kalyani R.; Solomon, Isaac H.; El-Mofty, Samir K.; Lewis, James S.; Chernock, Rebecca D. (2013). "Mammaglobin and S-100 immunoreactivity in salivary gland carcinomas other than mammary analogue secretory carcinoma". Human Pathology. 44 (11): 2501–2508. doi:10.1016/j.humpath.2013.06.010. ISSN 0046-8177.
  22. Castle JT, Thompson LD, Frommelt RA, Wenig BM, Kessler HP (1999). "Polymorphous low grade adenocarcinoma: a clinicopathologic study of 164 cases". Cancer. 86 (2): 207–19. PMID 10421256.

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