Acinic cell carcinoma differential diagnosis: Difference between revisions

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==Overview==
==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 salivary gland is made after the incision and by [[histology]] features which will provide a good [[chemotherapy]] regimen for so called patients.
[[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==
==Differentiating acinic cell carcinoma from other Diseases==
{|
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Category
! colspan="2" rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Benign/
Malignant
! colspan="6" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Clinical manifestation
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Paraclinical findings
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Gold standard diagnosis
! rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated findings
|-
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Demography
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |History
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Symptoms
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab findings
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-
! rowspan="5" align="center" style="background:#DCDCDC;" |[[Salivary gland neoplasm]]
! align="center" style="background:#DCDCDC;" |[[Pleomorphic adenoma]]<ref name="pmid22190789">{{cite journal |vauthors=Debnath SC, Adhyapok AK |title=Pleomorphic adenoma (benign mixed tumour) of the minor salivary glands of the upper lip |journal=J Maxillofac Oral Surg |volume=9 |issue=2 |pages=205–8 |date=June 2010 |pmid=22190789 |pmc=3244097 |doi=10.1007/s12663-010-0052-5 |url=}}</ref><ref name="pmid29845358">{{cite journal |vauthors=Kato H, Kawaguchi M, Ando T, Mizuta K, Aoki M, Matsuo M |title=Pleomorphic adenoma of salivary glands: common and uncommon CT and MR imaging features |journal=Jpn J Radiol |volume=36 |issue=8 |pages=463–471 |date=August 2018 |pmid=29845358 |doi=10.1007/s11604-018-0747-y |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
| align="left" style="background:#F5F5F5;" |
* More common in females
* [[Incidence]] increase with [[age]]
* [[Incidence]]: 2-3.5 cases per 100,000 [[population]]
| align="left" style="background:#F5F5F5;" |
* History of [[swelling]]
* [[Dysphagia]]
* [[Hoarseness]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | +
| align="left" style="background:#F5F5F5;" |
* Palpable [[mass]] of deep [[lobe]] of [[parotid gland]]
* Firm
* Mobile
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" |
* Proliferation of [[epithelial cells]] and [[stromal]] [[matrix]] in the [[ducts]]
| align="left" style="background:#F5F5F5;" |
* [[MRI]]: Homogenous on T1
* Abundant myxochondroid [[stroma]] on T2
| align="left" style="background:#F5F5F5;" |
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" | −
|-
! align="center" style="background:#DCDCDC;" |[[Warthin's tumor]]<ref name="pmid24376295">{{cite journal |vauthors=Chulam TC, Noronha Francisco AL, Goncalves Filho J, Pinto Alves CA, Kowalski LP |title=Warthin's tumour of the parotid gland: our experience |journal=Acta Otorhinolaryngol Ital |volume=33 |issue=6 |pages=393–7 |date=December 2013 |pmid=24376295 |doi= |url=}}</ref><ref name="urlWarthin tumor | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program">{{cite web |url=https://rarediseases.info.nih.gov/diseases/8569/warthin-tumor |title=Warthin tumor &#124; Genetic and Rare Diseases Information Center (GARD) – an NCATS Program |format= |work= |accessdate=}}</ref>
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
| align="left" style="background:#F5F5F5;" |
* [[Male]] to female ratio: 4:1
* More common in people aged 60-70 years old
| align="left" style="background:#F5F5F5;" |
* History of [[Swelling|swollen]] [[salivary gland]]
* [[Jaw]] pain
* [[Tinnitus]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | +
| align="left" style="background:#F5F5F5;" |
* Non tender
* Mobile
* Firm
* [[Solitary]]
| align="center" style="background:#F5F5F5;" | −
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" |
* [[Papillae]]
* [[Fibrous]] [[capsule]]
* [[Cystic]] spaces
| align="left" style="background:#F5F5F5;" |
*[[CT|Neck CT]]: [[Cystic]] lesion posteriorly within the [[parotid gland]]
*[[MRI]]: B/L heterogeneous lesions
| align="left" style="background:#F5F5F5;" |
* [[Biopsy]]
| align="center" style="background:#F5F5F5;" | −
|-
! align="center" style="background:#DCDCDC;" |[[Oncocytoma]]
<ref name="pmid277220032">{{cite journal |vauthors=Chen B, Hentzelman JI, Walker RJ, Lai JP |title=Oncocytoma of the Submandibular Gland: Diagnosis and Treatment Based on Clinicopathology |journal=Case Rep Otolaryngol |volume=2016 |issue= |pages=8719030 |date=2016 |pmid=27722003 |pmc=5045990 |doi=10.1155/2016/8719030 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
* [[Benign]]
| align="left" style="background:#F5F5F5;" |
*Race: [[Caucasian pop|Caucasian]] patients predilection
*Gender: No gender preference
*Age: 50–70 years
| align="left" style="background:#F5F5F5;" |
*Growing [[palpable]] painless mass
*[[Facial swelling]]
*[[Lymphadenopathy]] (if transformed to malignant)
| align="center" style="background:#F5F5F5;" | ±
| align="center" style="background:#F5F5F5;" | ±
| align="left" style="background:#F5F5F5;" |
* [[Firm]], multilobulated
* Mobile [[mass]]
| align="left" style="background:#F5F5F5;" |
*Normal
*Redness
*[[Swelling]]
*Skin [[ulceration]]
| align="left" style="background:#F5F5F5;" |
*Normal
*[[Anemia]]
| align="left" style="background:#F5F5F5;" |
* [[Epithelial cells]] with [[eosinophilic]]
* Granular [[cytoplasm]]
* Rich in [[mitochondria]]
| align="left" style="background:#F5F5F5;" |
*CT:
**Isodense expansive mass
**Enhancement after intravenous contrast
**Hypodense areas
*[[MRI]]:
**Isodensties on T1
**Mass is hyperintense on T2
**Enhancement on contrast
| align="left" style="background:#F5F5F5;" |
* [[Biopsy|Incisional biopsy]] and [[histopathological]] examination
| align="center" style="background:#F5F5F5;" |-
|-
! align="center" style="background:#DCDCDC;" |[[Monomorphic adenoma]] <ref name="pmid10889498">{{cite journal |vauthors=Kim KH, Sung MW, Kim JW, Koo JW |title=Pleomorphic adenoma of the trachea |journal=Otolaryngol Head Neck Surg |volume=123 |issue=1 Pt 1 |pages=147–8 |date=July 2000 |pmid=10889498 |doi=10.1067/mhn.2000.102809 |url=}}</ref><ref name="pmid24431845">{{cite journal |vauthors=Pramod Krishna B |title=Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child |journal=J Maxillofac Oral Surg |volume=12 |issue=2 |pages=228–31 |date=June 2013 |pmid=24431845 |pmc=3681990 |doi=10.1007/s12663-010-0125-5 |url=}}</ref><ref name="pmid30546932">{{cite journal |vauthors=Kessler AT, Bhatt AA |title=Review of the Major and Minor Salivary Glands, Part 2: Neoplasms and Tumor-like Lesions |journal=J Clin Imaging Sci |volume=8 |issue= |pages=48 |date=2018 |pmid=30546932 |pmc=6251244 |doi=10.4103/jcis.JCIS_46_18 |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
* [[Benign]] or [[malignant]]
| align="left" style="background:#F5F5F5;" |
*Age: 26-76 years
*Rare in children
*Gender: No predilection
| align="left" style="background:#F5F5F5;" |
*Growing [[palpable]] painless [[mass]] on jaw or in [[oral cavity]]
*[[Facial swelling]]
*[[Lymphadenopathy]] (if transformed to [[malignant]])
*[[Ulceration|Pain and ulceration]] (in later stage)
| align="center" style="background:#F5F5F5;" | ±
| align="center" style="background:#F5F5F5;" | ±
| align="left" style="background:#F5F5F5;" |
* [[Nodular]]
* Fluctuant [[swelling]]
| align="left" style="background:#F5F5F5;" |
*Normal
*Redness
*Skin [[ulceration]]
*May have [[lymphadenopathy]]
| align="left" style="background:#F5F5F5;" |
* Normal
| align="left" style="background:#F5F5F5;" |
*Straw colored fluid on [[aspiration]]
| align="left" style="background:#F5F5F5;" |
* [[Ultrasound]]:
**Used to [[biopsy]] the [[lesion]]
**May show cystic an solid components
* [[Computed tomography|CT:]]
**useful for [[lesions]] with [[calcification]] and venous phleboliths
* [[Magnetic resonance imaging|MRI:]]
**Test of choice
**Differentiate [[benign]] from [[malignant]]
**Defines [[tumor]] extent
**Shows perineural spread
| align="left" style="background:#F5F5F5;" |
* [[Biopsy|Incisional biopsy]] and [[Histopathological|histopathological examination]]
| align="center" style="background:#F5F5F5;" |-
|-
! align="center" style="background:#DCDCDC;" |[[Mucoepidermoid carcinoma]]
<ref name="pmid21243374">{{cite journal |vauthors=Chenevert J, Barnes LE, Chiosea SI |title=Mucoepidermoid carcinoma: a five-decade journey |journal=Virchows Arch. |volume=458 |issue=2 |pages=133–40 |date=February 2011 |pmid=21243374 |doi=10.1007/s00428-011-1040-y |url=}}</ref>
| align="left" style="background:#F5F5F5;" |
* [[Malignant]]
| align="left" style="background:#F5F5F5;" |
*Age: Mean age of 59
*Female predilection
| align="left" style="background:#F5F5F5;" |
*Painlesss [[mass]]
*[[Swelling]] in [[oral cavity]]
*[[Lymphadenopathy]]
| align="center" style="background:#F5F5F5;" | ±
| align="center" style="background:#F5F5F5;" | ±
| align="left" style="background:#F5F5F5;" |
* [[Cystic]] and [[Mass|solid mass]]
| align="left" style="background:#F5F5F5;" |
* May have [[lymphadenopathy]]
| align="center" style="background:#F5F5F5;" | −
| align="left" style="background:#F5F5F5;" |
* [[Gross examination|Gross findings]]:
**Firm
**Tan-white to yellow
**Bosselated
**Cystic
* [[Microscopic]] findings:
**Encapsulated 
**[[squamous]] and [[Glandular|glandular]] components
| align="left" style="background:#F5F5F5;" |
* Cystic and solid component with variable appearance on [[Computed tomography|CT]] and [[MRI]]
| align="left" style="background:#F5F5F5;" |
* Incisional [[biopsy]] and [[Histopathological|histopathological examination]]
| align="left" style="background:#F5F5F5;" |
* Association with [[CMV]]
|-
|}


===Differentiating acinic cell carcinoma from other diseases on the basis of histology findings===
===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, [[Oncocytoma|salivary oncocytoma]], [[mucoepidermoid carcinoma]], Mammary analog secretory carcinoma.<ref>{{cite journal|title=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|journal=The Journal of Pathology|volume=192|issue=4|year=2000|pages=564–565|issn=0022-3417|doi=10.1002/1096-9896(200012)192:4<564::AID-PATH737>3.0.CO;2-M}}</ref><ref name="Kumar2017">{{cite journal|last1=Kumar|first1=Uma|title=Acinic Cell Carcinoma Papillary-Cystic Variant: Diagnostic Pitfalls in Fine Needle Aspiration Cytology|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2017|issn=2249782X|doi=10.7860/JCDR/2017/21347.9772}}</ref>
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, [[Oncocytoma|salivary oncocytoma]], [[mucoepidermoid carcinoma]], Mammary analog secretory carcinoma.<ref>{{cite journal|title=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|journal=The Journal of Pathology|volume=192|issue=4|year=2000|pages=564–565|issn=0022-3417|doi=10.1002/1096-9896(200012)192:4<564::AID-PATH737>3.0.CO;2-M}}</ref><ref name="Kumar2017">{{cite journal|last1=Kumar|first1=Uma|title=Acinic Cell Carcinoma Papillary-Cystic Variant: Diagnostic Pitfalls in Fine Needle Aspiration Cytology|journal=JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH|year=2017|issn=2249782X|doi=10.7860/JCDR/2017/21347.9772}}</ref>


Revision as of 12:27, 27 September 2019

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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

Category Diseases Benign/

Malignant

Clinical manifestation Paraclinical findings Gold standard diagnosis Associated findings
Demography History Symptoms Signs Lab findings Histopathology Imaging
Salivary gland neoplasm 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
  • Association with CMV

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.[10][11]

Diseases Histological findings
Overlapping features Distinguishing features
Salivary metastasis of thyroid carcinoma[12] Empty appearance, grooves, pseudoinclusions Immunohistochemistry (Thyroglobulin)
salivary oncocytoma[13] Eosinophilic, non-serous cells Hematoxylin
mucoepidermoid carcinoma[14] Microcystic, and follicula, inconspicuous mucous/squamoid cells, eosinophilic Immunohistochemistry for p63
Mammary analoge secretory carcinoma[15] 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. ↑ "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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 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.
  15. ↑ 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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