Acinic cell carcinoma overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Acinic cell carcinoma is one of the salivary gland tumors. The symptoms of acinic cell carcinoma include enlarged salivary gland, nausea, vomiting and digestion problems. Treatments include surgery, chemotherapy, and radiation therapy. Godwin et al. first referred Acinic Cell Carcinoma almost 50 years prior. [1]
Historical Perspective
- The “acinar” term is derived from Latin term “acinus”, which means a cluster of and looks like grapes branch.
- The histological appearance is quite similar to secretory parenchymatous cells.
- Before discovering this disease, clinically Acinic Cell Carcinoma was unrecognized.
- At the time after recognizing the disease, it thought to be the nature of the tumor is benign.
- Afterward, it has been detected that the recurrence tendency of the tumor showed the possibility of the malignant nature of the tumor.
- Later WHO (World Health Organization) re-classified as a “malignant carcinoma” with low-grade behavior (2, 3).
Pathophysiology
Features of acinic cell carcinoma on fine needle aspiration include stippled chromatin and granular cytoplasm.
Microscopic Pathology
- Cytologic features of acinic cell carcinoma on fine needle aspiration:
- Chromatin stippled.
- Granular cytoplasm.
- Sheets of cells/acinar formation.
Differential diagnosis
Acinic cell carcinoma should be differentiated from parotitis, parotid gland benign tumor and mucoepidermoid carcinoma.
Epidemiology and demographics
Acinic cell carcinoma can appear at any age however, it is common in children.
- Acinic cell carcinoma appears in all age groups, but presents at a younger median age (approx. 52 years) than most other salivary gland cancers.
- Occurrences in children are quite common.
Risk factors
Radiation exposure and positive family history are known risk factors for acinic cell carcinoma.
Clinical data has suggested that the development of acinic cell carcinoma is related to several factors.
- Radiation exposure: Radiation treatment for the head and neck cancer increases the risk of developing salivary gland cancer. Workplace exposure to certain radioactive substances may also increase the risk of salivary gland cancer.
- Family history: Some epidemiological data suggest that members of some families seem to have a higher than usual risk of developing salivary gland cancers.
Screening
Screening is not recommended for acinic cell carcinoma.
Natural history, prognosis and complications
Acinic cell carcinoma is a slow growing tumor and it may affect the facial nerve or other adjacent tissues depending on its location. Prognosis is most favorable when the parotid gland is involved. Acinic cell carcinoma is a slow growing tumor and it may affect the facial nerve or other adjacent tissues depending on its location. Prognosis is most favorable when the parotid gland is involved. Progression of acinic cell carcinoma is slow but it may involve adjacent tissues if not treated adequately. Acinic cell carcinoma can spread to adjacent organs and eventually be lethal if not intervened on time. The prognosis is more favorable when the tumor is in a major salivary gland; the parotid gland is most favorable, then the submandibular gland; the least favorable primary sites are the sublingual and minor salivary glands. Large bulky tumors or high-grade tumors carry a poorer prognosis and may best be treated by surgical resection combined with postoperative radiation therapy.[2] The prognosis depends on the following:[3][4]
History and symptoms
Acinic cell carcinoma commonly presents with a mass in the neck, difficulty in swallowing and persistent pain.
Early acinic cell carcinoma does not have any symptoms. As the tumor grows larger, people may notice one or more of the following symptoms:
- A mass or lump in face, neck, or mouth area.
- Persistent pain.
- A newly noticed difference between the size and/or shape of the left and right sides of face or neck region.
- Numbness in part of face.
- New weakness of the muscles on one side of face.
- Pain and difficulty in swallowing.
Other diseases may also present with similar symptoms.
Physical Examination
Physical examination of neck may reveal a firm swelling and tenderness.
Staging
Staging of acinic cell carcinoma depends on tumor size and location.
Treatment
Patients with acinic cell carcinoma have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, or a combination of these methods.
- Surgery: Surgery is usually the main form of treatment for resectable salivary gland cancers.
- Radiation therapy: High-energy x-rays and other types of radiations are used to kill cancer cells from keep growing.
- Chemotherapy: The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing.
References
- ↑ Al-Zaher N, Obeid A, Al-Salam S, Al-Kayyali BS (2009). "Acinic cell carcinoma of the salivary glands: a literature review". Hematol Oncol Stem Cell Ther. 2 (1): 259–64. PMID 20063555.
- ↑ Parsons JT, Mendenhall WM, Stringer SP, Cassisi NJ, Million RR (1996). "Management of minor salivary gland carcinomas". Int J Radiat Oncol Biol Phys. 35 (3): 443–54. PMID 8655366.
- ↑ Vander Poorten VL, Balm AJ, Hilgers FJ, Tan IB, Loftus-Coll BM, Keus RB; et al. (1999). "The development of a prognostic score for patients with parotid carcinoma". Cancer. 85 (9): 2057–67. PMID 10223248.
- ↑ Terhaard CH, Lubsen H, Van der Tweel I, Hilgers FJ, Eijkenboom WM, Marres HA; et al. (2004). "Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group". Head Neck. 26 (8): 681–92, discussion 692-3. doi:10.1002/hed.10400. PMID 15287035.