MALIGNANT SALIVARY GLAND TUMORS

Mucoepidermoid carcinoma VS Adenoid Cystic Carcinoma VS Acinic Cell Adenocarcinoma

MALIGNANT SALIVARY GLAND TUMORS Definition

Mucoepidermoid carcinoma

Adenoid Cystic Carcinoma (ACC)

Acinic Cell Adenocarcinoma (ACA) A neoplastic growth of epithelial cells showing serous acinar differentiation All acinic cell tumors have some amount of malignant potential.

A malignant epithelial neoplasm of ductal (lumial) and myoepithelial (abluminal) cells growing in cribriform, tubular, solid and cystic patterns

Most common malignancy

salivary

gland

5-9% of salivary neoplasms Characteristics Parotid 45-70% of cases Palate 18% 3rd-8th decades, peak in 5th decade F>M Caucasian > African American Most common salivary gland tumor of children

Mucoepidermoid carcinoma

Adenoid Cystic Carcinoma (ACC) Overall 2nd most common malignancy

Acinic Cell Adenocarcinoma (ACA) Occurs most commonly in parotid gland Occurs unilaterally. May occur bilaterally. Occurs more frequently in women than men (3:2) Occurs in young and old individuals Slowly growing, mobile or fixed mass of various durations Asymptomatic Pain or tenderness

Clinical features

Presentation Low-grade: slow growing, painless mass High-grade: rapidly enlarging, +/- pain **Minor salivary glands: may be mistaken for benign or inflammatory process Hemangioma Papilloma Tori

Most common in palatae,submandibular, and minor salivary glands F> M 5th decade Presentation Asymptomatic enlarging mass or associated Pain, paresthesia, facial weakness/paralysis ACC has a marked tendency to spread through perineural spaces

Facial muscle weakness Well-circumscribed to partially encapsulated to unencapsulated Solid tumor with cystic spaces Gross pathology infiltrative Resemble P.A Well-circumscribed Solid, rarely with cystic spaces Well-demarcated Most often homogeneous

Mucoepidermoid carcinoma 3 types of cells (a)Mucous secreting cells -various shapes -abundant -pale foamy cytoplasm -stains +ve for mucin stains. (b)Epidermoid cells -polygonal -squamoid feature -intercellular bridges -rarely keratinization (c)Intermediate cells -resembles basaloid cells -LARGER than BASAL CELLS -smaller than sq. cells

Adenoid Cystic Carcinoma 1.Cribriform pattern Most common Basaloid epithelial cell nests forming multiple cylindrical cyst like patterns swiss cheese appearance

Acinic Cell Adenocarcinoma (ACA) 1.Different Patterns Sheets (Solid) Cysts, some with papillary growth Microcystic Follicles (similar to thyroid)

Histology

2.Tubular pattern Layered cells forming duct-like structures Basophilic mucinous substance

2.Acinar epithelium 3.Large polygonal 4.Lightly basophilic cytoplasm 5.Uniform to variable eccentric nuclei (blue dot tumors) 6.Cytoplasmic granules mucicarmine positive) (PAS positive;

7.Central lumen of various size

Mucoepidermoid carcinoma

Adenoid Cystic Carcinoma

Acinic Cell Adenocarcinoma (ACA)

3.Solid pattern Solid nests of cells without cystic or tubular spaces

Influenced by site, stage, grade Treatment & Prognosis Stage I & II Wide local excision Stage III & IV Radical excision +/- neck dissection +/- postoperative radiation therapy

Treatment Complete local excision Tendency for perineural invasion: facial nerve sacrifice Postoperative XRT Prognosis Local recurrence: 42% Distant metastasis: lung Indolent course: 5-year survival 75%, 20-year survival 13%

Treatment Complete local excision +/- postoperative XRT Prognosis 5-year survival: 82% 10-year survival: 68% 25-year survival: 50%