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Breast-malignant, males, children
Acinic cell carcinoma
Author: Nat Pernick, M.D, PathologyOutlines.com, Inc.
Reviewer: Daniel Visscher, M.D., University of Michigan Hospitals, February 2009 (see Reviewers page)
Revised: 7 September 2009
Last major update: September 2009
Copyright: (c) 2002-2009, PathologyOutlines.com, Inc.
Definition
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● Identical to salivary gland counterpart, has serous differentiation
● See also Salivary Glands chapter
● Although similar in some respects to secretory carcinoma (Histopathology 2002;40:223), it lacks its characteristic ETV6 gene rearrangement (Histopathology 2008;52:840)
Epidemiology
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● Uncommon in breast, <20 cases reported
Case reports
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● 42 year old woman (Virchows Arch 1996;429:69)
● 49 year old woman with death due to disease (J Clin Pathol 2002;55:545)
● Japanese woman (Pathol Int 2007;57:43)
Clinical
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● In salivary glands, may undergo high grade transformation (Am J Surg Pathol 2009;33:1137)
● In parotid gland, poorer prognosis if high mitotic activity and necrosis (Cancer 2009;115:2128)
Gross description
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● Often well circumscribed but may be infiltrative
● Gray-pink and hemorrhagic cut surface
● 2-5 cm
Microscopic description
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● Monotonous proliferation of cells with abundant finely granular cytoplasm, central round nuclei and prominent nucleoli, resembling acinic cells of salivary gland
● Often clear cells
● May have microglandular pattern (Virchows Arch 2000;437:74)
● Up to 15 mitotic figures/10 HPF
● May be mixed with ductal carcinoma-like cells (Am Surg 2002;68:993)
Micro images
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Tumor cells have prominent Post-chemotherapy tumor has cells with
cytoplasmic granularity clear vacuolated cytoplasm
Fig A/B
Salivary gland tumors:
Papillary fronds with hobnail cells Microcystic and solid patterns
and vacuolated cells in tumors from father and daughter
Tumor with clear cells Dedifferentiated tumor
Various micro images
Fig 1: Dedifferentiated parotid tumor with some classic areas; Fig 2: Mitotic figures and necrosis; Fig 3: Differentiated areas with basophilic cytoplasm and vesicular nuclei; Fig 4: PAS+ diastase resistant granules
Cytology images
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Salivary gland:
Acinar-like cells with larger nuclei, no ducts, no fibrofatty stroma, no “bunch of grapes” architecture
Positive stains
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● CK7, Amylase
● Granules are PAS+ diastase resistant
● Also lysozyme, EMA, myoepithelial markers (including S100)
Negative stains
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● ER, PR, HER2, CK20
Electron microscopy
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● Multiple round, electron dense, cytoplasmic secretory granules
Electron microscopy images
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Electron dense granules Clear cells in post-chemotherapy patient
have dilated endoplasmic reticulum
Additional references
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End of Breast – Malignant, Males, Children > Acinic cell carcinoma
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