Acinic cell carcinoma of the salivary gland associated with lymphoid‐rich stroma. A diagnostic dilemma on cytology: Study of two cases

Mir, Fatima; Rohra, Prih; Aakash, Nfn; Furlan, Karina; Cheng, Lin; Ghai, Ritu; Reddy, Vijaya B.; Gattuso, Paolo

doi:10.1002/dc.24571

Cited by 8 publications

(27 citation statements)

References 17 publications

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“…21 The abundance of this lymphoid population can lead to a sampling error and potential misdiagnosis of ACC with FNA or core needle biopsy. 22,23 Anecdotally, 1 patient in this series had an initial FNA of his left parotid mass diagnosed as reactive lymphoid hyperplasia with confirmatory normal flow cytometry. Because no tissue follow-up occurred, that aspirate is not included as part of our series, but when he returned 6 years later with a large mass in the same region diagnosed as high-grade carcinoma (case 38) and subsequently confirmed as ACC-HGT with metastases to mediastinal lymph nodes (cases 39 and 40), it was tempting to speculate that tumor-associated lymphoid proliferation was responsible for a latent conventional ACC not being recognized during his initial presentation.…”

Section: Discussionmentioning

confidence: 95%

Cytopathology of acinic cell carcinoma: A study of 50 cases, including 9 with high‐grade transformation

Wakely

Lott-Limbach

2021

Cancer Cytopathology

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BACKGROUND:Although largely readily recognizable in tissue sections, acinic cell carcinoma (ACC) remains diagnostically problematic in fine-needle aspiration (FNA) cytopathology. The authors undertook an analysis of a large series of ACC aspirates, including acinic cell carcinoma with high-grade transformation (ACC-HGT). METHODS: The authors searched their cytopathology files for ACC cases with histopathologic confirmation. FNA biopsy was performed according to standard techniques. RESULTS: Fifty FNA biopsy cases of ACC (including 36 of parotid origin [72%]) from 41 patients (female to male ratio, 1.4:1; age range, 23-84 years; average, 54 years) met the study inclusion requirements. Primary neoplasm aspirates were most common (72%), and they were followed by recurrent tumors (16%) and metastases (12%). A precise cytologic diagnosis was made for 64%. Three of 9 ACC-HGT cases (33%) were correctly interpreted as such; 98% of conventional ACC cases were correctly graded as low-grade. With the Milan classification system, 74% fit into the malignant category.Ancillary testing was performed for only 36%. Conventional ACC had moderately to highly cellular smears; monotonous cells in aggregates and single forms; rounded nuclei; and microvacuolated, finely granular, oncocyte-like, or nonspecific cytoplasm. ACC-HGT smears contained larger nuclei, high nuclear to cytoplasmic ratios, coarse nuclear chromatin, and a loss of cytoplasmic granules/vacuoles. CONCLUSIONS: A correct diagnosis of ACC via FNA biopsy was made in almost two-thirds of the cases. With the Milan classification, 84% of the cases would have been classified as malignant or suspicious for malignancy. An absence of conventional serous acinar cell morphology in some cases as well as an absence of ancillary immunohistochemistry testing in almost two-thirds of the cases prevented even better diagnostic performance. Cancer

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Section: Discussionmentioning

confidence: 95%

Cytopathology of acinic cell carcinoma: A study of 50 cases, including 9 with high‐grade transformation

Wakely

Lott-Limbach

2021

Cancer Cytopathology

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“…Moreover,10%-29% of AciCCs are associated with TALP, which may lead to misdiagnoses of the tumors as reactive lymph nodes. 5,6 Some studies have shown that the diagnosis of AciCC was correctly made in only two-thirds of the cases, largely due to the absence of conventional serous acinar morphology and/or lack of ancillary studies. 18 Indeed, FNAC of AciCC is not infrequently categorized as oncocytic/oncocytoid SUMP (category IVB) in the Milan System.…”

Section: Discussionmentioning

confidence: 99%

“…Because of the delicate cytoplasm of the neoplastic epithelial cells, cytologic preparations of AciCC may yield tumor cells with stripped bare nuclei, which may resemble lymphocytes, particularly on conventional smear preparations. Moreover,10%–29% of AciCCs are associated with TALP, which may lead to misdiagnoses of the tumors as reactive lymph nodes 5,6 . Some studies have shown that the diagnosis of AciCC was correctly made in only two‐thirds of the cases, largely due to the absence of conventional serous acinar morphology and/or lack of ancillary studies 18 .…”

Section: Discussionmentioning

confidence: 99%

“…The presence of TALP may lead to the misdiagnosis of AciCC as intraparotid lymph nodes, Warthin tumor (WT), or lymphoepithelial lesions. 5,6 AciCC is sometimes classified as oncocytic/oncocytoid salivary gland neoplasm of uncertain malignant potential (Milan category IVB: SUMP) when using the Milan System for reporting salivary gland cytopathology. In addition to AciCC, the Milan IVB oncocytic/oncocytoid subgroup also incorporates other neoplastic entities, including WT, oncocytoma, MEC, secretory carcinoma (SC), pleomorphic adenoma (PA), and salivary duct carcinoma (SDC) and is associated with a reported risk of malignancy ranging from 7.7% to 61.1%.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, 10%–29% of AciCC have been associated with lymphoid‐rich stroma or tumor‐associated lymphoid proliferation (TALP). The presence of TALP may lead to the misdiagnosis of AciCC as intraparotid lymph nodes, Warthin tumor (WT), or lymphoepithelial lesions 5,6 …”

Section: Introductionmentioning

confidence: 99%

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Utility of NR4A3 on FNA cytology smears and liquid‐based preparations of salivary gland

Millan

Tjendra

Zuo

et al. 2022

Cancer Cytopathology

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BACKGROUND: Fine-needle aspiration cytology (FNAC) is generally the initial sampling method for salivary gland neoplasms.The cytomorphologic features of acinic cell carcinoma (AciCC) of salivary gland can overlap with other neoplastic and nonneoplastic entities. AciCCs harbor a recurrent t(4;9) rearrangement with upregulation of nuclear receptor subfamily 4 group A member 3 (NR4A3). NR4A3 protein overexpression has been shown to be highly sensitive and specific for the diagnosis of AciCC in histologic specimens and cell block preparations. However, data on NR4A3 immunocytochemistry (ICC) on conventional smears or liquid-based cytology are limited. METHODS: The authors identified 18 FNAC of histologically proven AciCC cases between 2013 and 2019. FNAC samples of diagnostic mimickers were likewise retrieved and included in the study cohort for comparison. The NOR1/NR4A3 mouse monoclonal antibody was applied directly to FNAC slides using a standard ICC technique. RESULTS: The cohort included ethanol-fixed Papanicolaou-stained cytologic smears and liquid-based preparations from 18 AciCC, one secretory carcinoma, four mucoepidermoid carcinomas, four salivary duct carcinomas, five pleomorphic adenomas (PA), five Warthin tumors, five oncocytomas, one oncocytic hyperplasia, and five nonneoplastic salivary gland cases.Strong nuclear staining for NR4A3 was present in all AciCC, weak nuclear staining was present in one PA, and all other non-AciCC were negative (sensitivity, 100%; specificity, 97%). CONCLUSIONS: NR4A3 ICC can be used directly on FNAC conventional smears and liquid-based cytology to reliably distinguish AciCC from its mimickers. This marker may be useful in cases where a cell block preparation is unavailable or inadequate.

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Acinic cell carcinoma mimicking Warthin's tumor: A diagnostic challenge on fine‐needle cytology

Yaprak Bayrak,

Ozturk

2023

Diagnostic Cytopathology

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The cytologic diagnosis of acinic cell carcinoma (ACC) can be challenging due to its polymorphous appearance and sharing cytomorphologic characteristics with other benign and malignant neoplasms as well as non‐neoplastic diseases, even though various histomorphological aspects of ACC have been documented. We presented a 39‐year‐old female patient applied with right pre‐auricular parotid swelling spreading infra‐auricular region which was gradually increased in size for 3 months. Ultrasonographic examination revealed hypoechoic well‐circumscribed mass with 17 × 22 × 29 mm size. Magnetic resonance imaging revealed intra‐parotid solid lesion with cystic areas, slightly hypointense on T1 and hyperintense on T2 weighted images. The mass was pushing the retromandibular vein medially, still lateral to it in the caudal images, but in dumbbell‐shape spreading through parapharyngeal space in superiorly cranial images. Fine‐needle aspiration cytology was also performed with guidance of ultrasonography. The cytological examination of the lesion was characterized by the predominance of heterogeneous lymphoid cells, clusters of epithelial cells with a variety of cytologic appearances, including granular, transparent, vacuolated, and oncocytic, and the presence of numerous naked nuclei with a protein‐like foamy background. Due to intense lymphocytic inflammation, it was considered as benign primary parotid tumor such as Warthin's tumor. The excision material was examined histopathologically. Immunohistochemical analysis showed that this carcinoma was positive for DOG1, SOX10, cytokeratin 7 and negative for mammaglobin. This salivary gland tumor was reported as a rare variant of ACC with lymphoid‐rich stroma. To improve the diagnostic accuracy, various morphological aspects of ACC should be considered in the pathological practice.

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Acinic cell carcinoma of the salivary gland associated with lymphoid‐rich stroma. A diagnostic dilemma on cytology: Study of two cases

Cited by 8 publications

References 17 publications

Cytopathology of acinic cell carcinoma: A study of 50 cases, including 9 with high‐grade transformation

Cytopathology of acinic cell carcinoma: A study of 50 cases, including 9 with high‐grade transformation

Utility of NR4A3 on FNA cytology smears and liquid‐based preparations of salivary gland

Acinic cell carcinoma mimicking Warthin's tumor: A diagnostic challenge on fine‐needle cytology

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